If you’ve worked even a single shift in a hospital, you’ve heard it during the handoff (handover): “That patient in bed B1 is challenging. Just a heads up. Know how to deal with him.” But why the “Difficult Patient” label?
In an instant, your internal defences go up. Before you’ve even stepped into the room or looked into the patient’s eyes, you have labelled them. You expect conflict, so you approach the room/ward with a clinical coldness, ready to “manage” the behaviour rather than care for the person.
But what if we’ve been looking at it all wrong? What if the “difficult patient” is actually a myth, a symptom of a system that forgets what it feels like to be human? What if that’s one of the reasons your shift wasn’t so smooth?
The Mirror Test: Seeing the Person Under the Gown
Let’s try a “Mirror Test.” Take a moment to step away from your role as a nurse and imagine yourself as the person in that bed.
You are stripped of your clothes and given a thin, open-backed gown. You are in a sterile room where you can’t control the temperature, the lighting, or who walks through the door. You are likely in pain, perhaps facing a life-altering diagnosis, and waiting for hours for updates that feel like they’ll never come. You haven’t slept because the IV pump is beeping, and your dignity is resting in the hands of strangers.
In that scenario, how would you react? Would you be “pleasant and cooperative,” or would you be demanding, irritable, and loud?
The “difficult” behaviours we see, the constant call-light pressing, the snapping at staff, the refusal of meds, are rarely about us. The patients are a desperate, subconscious attempt to regain some shred of autonomy in a situation where they have none.
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The Power of Language: The Relabeling Exercise
The words we use in the breakroom and during reports matter. Labels like “non-compliant,” “combative,” or “difficult” are clinical shortcuts that strip away empathy and understanding. To shift our perspective, we need to change our vocabulary.
Try this relabeling exercise during your next shift:
- Instead of “Uncooperative”, try: “Struggling with a loss of control.”
- Instead of “Attention-seeking”, try: “Feeling unsafe or unheard.”
- Instead of “Aggressive”, try: “Overwhelmed by fear and pain.”
- Instead of “Demanding”, try: “Anxious about the plan of care.”
When you change the label, your nursing intervention changes. Your defences drop. You stop trying to “fix the attitude” and start trying to “address the fear.”
The Science of Bias in Handoffs
This isn’t just about being “nice.” Research shows that negative labels in medical records can actually lead to lower-quality care. A study published in the Journal of General Internal Medicine found that when physicians read a chart with stigmatizing language (like “the patient is a known drug-seeker”), they were less likely to offer aggressive pain management and had less empathy for the patient (Goddu et al., 2018).
Nurses are the frontline of the patient experience. If we start the shift by labelling a patient as “difficult,” we are statistically more likely to spend less time in their room, which in turn makes the patient feel more ignored and, you guessed it, more “difficult.”
How to Flip the Script
The next time a colleague tells you a patient is “a nightmare,” take it as a challenge to find the source of their distress.
- Acknowledge the Fear: Sometimes just saying, “I can see you’re really frustrated. This is a scary place to be,” can de-escalate a situation faster than any sedative.
- Give Back Control: Ask small questions. “Would you like your bath now or after lunch?” “Should I leave the door open or closed?” These tiny choices help restore a patient’s sense of self.
- Check Your Own Energy: If you walk in expecting a fight, your body language will show it(this is natural). Take a deep breath before entering the room and reset your “internal mirror.”
Conclusion: Why the “Difficult Patient” Shouldn’t Be Used By Nurses
Labelling a patient is easy; understanding them is hard. But as nurses, we aren’t here because the job is easy. We are here because we have the unique ability to see the human being beneath the diagnosis.
By ditching the “difficult” label, we don’t just make our shifts easier, we restore the dignity that the hospital system so often takes away.
References:
Goddu, A. P., et al. (2018). Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record. Journal of General Internal Medicine.
