Таълим вазирлиги ўзбекистон республикаси соғЛИҚни сақлаш

FEATURES OF CONSULTATION OF THE DIFFICULT PEDIATRIC 
PATIENTS AS IMPORTANT PRACTICAL SKILL OF GP DOCTORS. 
 
Makhkamova G.T., Isakhanova N.H. 
The Tashkent pediatric medical institute 
None of my consultations which were done as GP or none of them as a 
patient were similar. All of them are unique in own way. There are a lot of factors 

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influencing efficiency of consultation (clinic resources, competence of the doctor, 
etc.) and the difficult patient can be one of its examples. The difficult patient is not 
severe and in many cases is not difficult in sense of diagnostics or treatment. He is 
not convenient, not convenient for this doctor. Parents of sick children can be 
difficult patients too. Sleepless nights being spent at the bed of child, experience of 
a medical mistakes or rudeness of doctors can change their relation to consultation 
of their child, also:
- The child with a tumor, a HIV infected 
- The child with congenital anomalies 
- The unique and long-awaited child in families
- The child or parents with mental diseases 
- The child with psychosomatic diseases 
- The child with severe pains 
- Uneducated parents 
- A family with economic problems (poverty, unemployment, refugees) 
- Mother with depression, etc. 
GP who consults till 15-20 patients, a day deals with 1-2 difficult patients. 
But in practice most of things depend on doctor. According to practice one doctor 
can have 2-3 difficult patients a day, but another may have 2-3 difficult patients a 
month. In each of these cases doctor should look through PUNs and DENs 
(Patient’s unmet needs and doctor’s educational needs) [1, 4, 6].
There is no any argue in their requiring more time and effort from doctor. 
Each of these patients is followed by the special approach, but at the same time 
there are general principles of consultation. More time should be spent to 
consultations of difficult patients than usual ones. If the average number of 
difficult patients is 1-2 a day, 20-30 minutes of consultation is available for 
them[1, 4, 6]. Not hurrying up is a basis of consultation. Parents seeing that doctor 
is not hurrying up believe that he and his problems are important to the doctor. In 
the end of consultation it is important to give time to patients to think and ask 
questions. It is important to ask: «Do you have any more questions? », «Is it all 
clear for you? ». 
Every sick person is potentially difficult patient or on the contrary, every 
difficult patient is potentially ordinal. The severe or long current of a usual flu can 
make the patient aggressive.