The entitled demander
The entitled demander is fundamentally similar to the dependent clinger in terms of his or her neediness; however, this patient’s demeanor is quite different. This patient can be demanding, devaluing, insistent, hostile, on the attack, and intimidating. The entitled demander may threaten to bring lawsuits against the physician, or con- tact the patient relations department when the surgeon does not respond to his or her demands. The primary state of this patient is one of entitlement. This state is actually a defense against feelings of loss of control and helplessness. However, when a physician is at the other end of the angry demands and entitled behavior, it is easy to understand how one could become enraged with this patient. An entitled demander makes the physician feel fearful of their threats, such as threat of a lawsuit or a threat to contact the patient relations department and file a complaint. A typical physician’s reaction to this patient is to let him or her know, in no uncertain terms, how undeserving they are of what they are demanding. When the physician reacts in this fashion, the patient becomes even more enraged, demanding, and threatening.
Dr. Groves speaks eloquently about how to handle such a patient, by addressing the patient as follows:
You say you’re entitled to repeated tests, damages for suffering and all that. And you are entitled— entitled to the very best medical care we can give you. But we can’t give you the good treatment you deserve unless you help. You deserve a chance to control this disease; you deserve all the allies you can get. You’ll get the help you deserve if you’ll stop misdirecting your anger to the very people who are trying to help you get what you deserve—good medical care.
Dr. Groves’ approach enables the physician to tactfully address the entitled and demanding behavior in a constructive manner, rather than to respond with rage and retaliation, which are natural responses to this kind of mistreatment. This approach allows the patient to gratify his or her underlying belief in their entitlement, and re- inforces their wish to receive the best medical care.