We all have them, but no one wants them--difficult patients.  I’m not talking about patients with complex medical conditions.  I’m talking about patients who try your patience. The occurrence is so frequent that Seinfeld had an episode devoted to the problem, though for the doctor and the real patient it is not so humorous.  For over 30 years researchers have found that doctors have consistently described about 15-20% of their patients as ‘difficult’.  More detailed surveys have found that doctors who are younger and female tend to have more ‘difficult’ patients in their practice.

The Patient Protection and Affordable Care Act (PPACA) may cause your office some headaches because of the “Patient Protection” aspects of the legislation. There have been high profile cases recently, in which Cignet Health and Massachusetts General Hospital, which were recently hit with $4.3 million and $1 million fines, respectively, due to federal HIPAA privacy and security violations. Donald L. Bradfield, senior counsel in the legal department of Johns Hopkins Health System warns doctors and hospital compliance officers about the teeth that the HHS office for Civil Rights (OCR), which enforces HIPAA regulations, seems to have found.

In this era when concepts such as "transparency in healthcare" or "informed consumers" are used often, some are saying that too much patient information leads to poor decisions by patients or their families.  How much information should you provide to your patients so that you comply with your legal obligations, while allowing your patients to make an informed decision?  The bare minimum of information that you should give your patients is that which is required by your state to meet the legal ‘informed consent’ standard.  Do you need to provide any more information than this?

Albert Einstein was once asked how he went about solving his problems.  He replied, “If I had only one hour, I’d spend the first 50 minutes defining the problem and the last 10 minutes solving it.”  I don’t know if this story is true or not, because I have heard the same story about a lumberjack, who, when asked how he would go about felling a tree in one hour reply, “I’d spend the first 50 minutes sharpening my ax and the last 10 minutes felling the tree.”  The point of these stories is that the key to solving any problem is to accurately define the problem.