Treating the Difficult Patient: How to Approach a Patient with Delusional Infestation

Patients are often labeled as “difficult” by medical providers when they are (1) medically complicated, (2) have limited access to care, or (3) are unable to play well with others. In this chapter, we focus on the third type of difficult patient—those who tend to exasperate the provider due to unreasonable expectations, unlikability, or threatening behavior when needs are unmet. Patients with delusional infestation (DI) are frequently categorized as “difficult,” as they require more time with visits and seem less satisfied than other dermatology patients (Reichenberg et al., J Am Acad Dermatol 68(1):41–6, 2013). In this chapter, we will review the characteristics of the difficult patient and provide ten clinical pearls to help improve interactions between the provider and the patient. Our goal is to reduce frustration for the provider, as well as to improve patient satisfaction and outcomes.