Not all Sunshine and Rainbows: How to handle Difficult patients and their families

Featuring faculty, Leigh Ann Rola, MPAS, PA-C and panelists, Dr. James Treat and Dr. Sheilagh Maguiness

Physician assistant Leigh Ann Rola, along with panel presenters Dr. Treat and Dr. Maguiness, presented an engaging lecture on how to approach difficult patients and their families. She began her presentation highlighting the numerous factors that can contribute to challenging situations including complex family dynamics, cost of medications, insurance issues, travel costs, multiple caregivers and non-compliance. Leigh Ann encouraged always starting with empathy, followed by education and empowering the children and their families. Furthermore, she encouraged providers consult with their medical team for their expertise and experience in helping you provide the best care to these patients. Ms. Powers revealed a journal article that can be used as a resource on how to approach the difficult parent/patient encounter.

Next, Ms. Rola utilized case presentations to illustrate challenging clinical situations. Arthropod bites can be difficult to approach as patients and their families may not even believe the diagnosis. One key in helping these patients is education on how long a bite can cause symptoms. For example, the venom or feces from an arthropod can live in the skin for up to a year. Examples of treatments for these patients include oral antihistamines, topical steroids or medicated moisturizers.

Arthropod bites can be difficult to approach as patients and their families may not even believe the diagnosis.

Another challenging presentation is trichotillomania. There is no perfect way to handle these patients as it can be a very sensitive conversation and many patients are not forthcoming with their behavior. Ms. Rola encourages positive reinforcement, for example suggesting to a patient that it may not be purposeful hair pulling, but could be from “twirling” hair. Options for management can include N-acetyl cysteine, cognitive behavioral therapy and reassurance of healthy scalp and hair. Telogen effluvium is another example where positive reassurance is encouraged. Further, Ms. Rola discussed evaluations and intervention of acne “picking” behavior.

Lastly, lichen sclerosis et atrophicus often presents with a great deal of itching and can be mistaken for irritant dermatitis, yeast infection, abuse or vitiligo. A way to differentiate vitiligo from lichen sclerosis et atrophicus in darker pigmented individual is that vitiligo is not itchy. Barriers, gentle skin care, topical steroid and close follow up are essential as it can leave to scarring and adhesions long term.