The help-rejecting complainer
The help-rejecting complainer will try to thwart any help offered to them. After their refusal to follow the physician’s instructions, these patients tend to express their feelings of hopelessness by stating that no doctor can help them. Week after week, he or she returns to the doctor’s office to assert that the recommended treatment has failed once again. When the physician is exhausted, the patient declares that the treatment has been un- successful. The physician ends up feeling tortured by the patient.
Like the dependent clinger and the entitled demander, the help-rejecting complainer can be viewed as a bottomless pit of need. They seem to wish an undivorceable marriage with their physician, yet they do not seem to wish to get well.4 When one symptom resolves, another magically appears to replace it. These patients often suffer from undiagnosed and untreated depression.
This patient group makes physicians feel help- less, anxious, and uncertain about their clinical skills. It is usually not constructive to confront this patient about his or her self-defeating behav- ior. It is important to realize that the patient’s goal is to always be connected to the doctor. They are terrified that if they get better, that they will lose that relationship with the physician.
A good strategy for the physician is to share the help-rejecting complainer’s pessimism that they cannot be “cured.” The physician could suggest treatments that may provide partial relief (but not enough that the patient will be cured, thereby provoking fear in the patient of losing the physician). The physician has to guard against trying to “turf” the patient to another
physician, so he or she will be someone else’s headache, as tempting as it might be to do so; in any event, the patient would likely refuse to see another doctor. It is also important to note that consultation with a psychiatrist can be helpful in this situation, but not as a replacement for the primary physician; psychiatric care must be presented as an adjunctive treatment.