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Difficult patients or professionals' failure to fully see the disorder?

“Difficult patients”. I’ve heard this term a lot. But what does this really mean?


Maybe they didn’t follow our recommendations and we labeled them as “non-compliant”. Maybe they came across as “not stimulable”. Maybe they just came across as a person whose personality would be hard to work with.


But what if it’s not them and it’s us? What if it’s our own judgements or perceptions?

What if their “difficult” nature was coming from the fact that they had seen 10 doctors before this and were at their wit’s end dealing with significant coughing or voice impairments for years that significantly decreases their quality of life?

What if their “non-stimulable” presentation was just not stimulable with one thing that we tried with them or how we presented it? What if we made assumptions that therapy wouldn’t work before we tried other things?


What if their “difficult” personality was really coming from a place of wanting to advocate for themselves or from a place of fear that they would never get an answer or resolution of symptoms?


It’s easy to label and it’s easy to make quick judgements or assumptions.


I’ve found that most of the individuals I’ve worked with who initially were marked as “difficult” patients or who seemed the most resistant to working with an SLP ended up being the most dedicated.


But it takes us clinicians breaking down that barrier. Of truly seeing the person and putting ourselves in their shoes. Of establishing us as experts, yes, but also as fellow humans.

Just imagine if you had been to 10 doctors, have struggled to speak or cough in every setting for YEARS and you’ve tried a million and one solutions you’d probably be [insert adjectives here] (frustrated, hopeless, sad, skeptical, adamant about knowing your own symptoms, and aggressive about making sure you understand your recommended care plan).


I find it so helpful to listen. To acknowledge. Without judgement. To learn not just what’s happening now but the journey that brought them to your office because that’s so very important to the success of therapy.



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