“Action for traction with the Stress Difficile patient”

Course Administration

  • Course tuition $1300.00 [Cdn] includes all course materials [tax creditable in Canada]
  • Duration Eight two-hour online classes … completed in one month
  • Class schedule Classes meet twice per week. Thursday and Sunday at 6:00 P.M. [PST]
  • Accredited This program has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 16 Mainpro-M1 credits
  • Next start date May 7, 2015


  • To register or to request further information: Contact Margaret Dopson, MASc, Director, Distance Training, Canadian Institute of Stress   mdopson@stresscanada.org


Course Announcement

The online “Action for traction with the Stress Difficile patient” course has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 16 Mainpro-M1 credits.

Developed by Canadian family physicians [FP] working with Dr. Hans Selye’s Canadian Institute of Stress, this eight-class online course provides practice-based insights plus an evidence-based protocol for brief counseling with such patients. It is systematic, defensible and EMR-compatible. Launch date is May 7, 2015.


Hallmarks of the Stress Difficile patient

  1. Secondary gain from frequent family doctor visits has become their primary gain
  2. Typically over-stressed and unwell
  3. Their presentation is typically confusing, time consuming and ambiguous
  4. Their past therapeutic compliance and prognosis are routinely poor, resulting in
  5. FP’s assess their effectiveness and professional satisfaction with SD patients at 30% and 40% lower, respectively, than with typical patients


Practice management implications

SD patients comprise as much as 30% of FPs’ patient rosters. The mean estimate per FP practice roster is 15% of all patients. Anecdotal evidence suggests that SD patients consume on average 2.2 times more of an FP’s time per encounter than do typical patients.

FP’s rate (a) their professional effectiveness in treating SD patients as 30% below that experienced in treating their typical patient, and rate (b) their professional satisfaction in treating SD patients as being 40% lower. FPs’ overall professional return-on-effort with SD patients is, therefore, estimated as 65% of that experienced with typical FP practice patients … a shortfall of 35%.

Experienced instructors, online interactive, convenient & practice-focused

Your course instructors are Murray Woods, MD, a British Columbia FP, and Richard Earle, Ph.D., Managing Director of the Canadian Institute of Stress. Each has more than 25 years’ experience in working with SD patients.

Opportunities for in-class online interaction with the instructors and with your colleagues are an enjoyable feature. As is being able to learn from home, or office, or on a beach … wherever you have high-speed internet access.


Course Curriculum: Module learning objectives

Course Goal:

To better understand the Stress Difficile [SD] patient, and to learn strategies that can produce improved clinical outcomes and greater professional satisfaction in dealing with this patient group.

In the following eight modules, physician participants will learn:

Module 1

  1. How to systematically work with this course’s learning format, materials and exercises (a) to fully benefit from its perspectives & tools and (b) to integrate its learnings most beneficially into the clinical setting
  2. How to apply a working definition [clinical & behavioural characteristics] of the “Stress Difficile” [SD] to patients in their own practice
  3. How to identify and assess the primary effects of SD patients on their practice efficiency and on their professional effectiveness and satisfaction
  4. How to apply a synopsis of 25-years’ clinical and administrative guidelines from a Family Practitioner [FP] trenchman regarding the clinical, ethical and practice-management challenges arising from SD patients

Module 2

  1. Based on MD homework from Module 1, how to refine and apply the SD sniffer test’s early warning signs in routine clinical practice
  2. How applying this course’s Stress & Wellness counseling protocol [presented step-by-step in Modules 3 to 8 including need-to-know recording forms] in its evidence-based design, to create improved outcomes for the SD patient and for the treating FP
  3. How to apply a distilled model of patient motivation which accounts for poor to superior motivation and compliance in the SD patient
  4. How to strategically shift the patient’s motivation to create improved treatment outcomes. Case studies are provided to illustrate the application of the model in order to stimulate improved patient motivation

Module 3 Intake office visit

  1. To evaluate (a) Pt’s appropriateness for brief counseling, and (b) Pt’s likely effort, motivation and compliance in the counseling process
  2. To apply a brief “Stress Signs / Patterns” checklist
  3. To identify the Pt’s stage in “Five Stages of Stress Impacts on Wellbeing”
  4. To clarify the roles of stress in predisposing, precipitating or perpetuating Pt’s problem(s)
  5. To evaluate Pt motivations for “getting better”

Module 4 Brief counseling protocol: Counseling session # 1

  1. To identify the Pt’s personal top-priority-for-action using the “Pillars of Wellness” Test … as the basis for engaging, motivating and focusing the patient’s Action in brief counseling
  2. To identify Pt’s top priority-for-action Wellness Pillar … based on Pt’s scores & Pt’s probability for successful action ie “Is this achievable?” see Learning Objective #5.
  3. How to assist SD Pts who are “stuck” (unsure which Pillar is most motivating to focus on for action)
  4. To use questions to discover the specific ways in which the priority Pillar is most frequently causing the Pt discomfort, distress or impaired functioning (ie how it “hurts”)
  5. To guide the Pt in using their own words to precisely describe themselves living “better” within their top priority Pillar

Module 5 Brief counseling protocol: Counseling session # 2

  1. To identify their most important “work satisfiers” in their own family practice
  2. To identify one or two manageable steps they could individually take to significantly improve their experience of work satisfaction
  3. To summarize for Pt how progress depends on CLEAR Goals, Satisfaction, Opportunity Situations and repeatedly taking Action
  4. To review the Pt’s Homework: their one or at most two proposed actions
  5. To guide the Pt in using their own words to precisely describe themselves beginning to live “better” outcomes in top priority Pillar
  6. To reinforce how that would specifically affect Pt’s selected indicators of their distress (or satisfaction)

Module 6 Brief counseling protocol: Counseling session # 3

  1. To identify how taking small manageable actions based in their personal “winner strengths” can make their work satisfaction more actionable, optimistic and achievable
  2. To review the Pt’s Homework: their several additional proposed action(s) for living “better”
  3. For reinforcement, invite them to recap how they had selected one of their proposed actions
  4. To evaluate the Pt’s Action #1 per criteria of Small, Specific, Motivating and Achievable

Module 7 Brief counseling protocol: Counseling session # 4

  1. To identify (a) their most important criteria which define professionally successful and satisfying counseling with patients, and (b) several manageable actions they could take to experience such success and satisfaction more fully / more frequently
  2. To summarize with Pt their progress per *success factors, *recurring obstacles, and *most important lessons learned in creating success in agreed Actions
  3. To decide whether Pt progress warrants (a) revising Pt’s existing Actions, or (b) adding >1 new Action
  4. To refine and continue applying Module 6 counseling steps
  5. To systematically evaluate and record, “My professional success and satisfaction in this counseling relationship”

Module 8 Clinically appropriate, defensible FP decision making

  1. From MD homework … How to re-evaluate (a) Pt’s appropriateness for brief counseling, and (b) their effort, motivation and compliance in agreed steps

2a To refine and continue applying Module 6 counseling steps. Or …

2b To systematically / defensibly reach best possible decisions re (i) continuing, (ii) discontinuing or (iii) changing the doctor-patient relationship