Not every day in the life of clinicians is full of joy and self-fulfillment. Apart from stresses and strains associated with providing effective patient care, some individuals on the receiving end of treatment warrant special attention. Welcome to the kvetching arena. The verb kvetch is a Yiddish term defined in the Oxford English Dictionary as “To criticize or complain a great deal.” A paper by Yager and Kay in the January 2024 issue of the Journal of Nervous & Mental Disease indicates that clinicians often encounter patients whose presentations are characterized by long lists of complaints about their biological, psychological, interpersonal, and social conditions. The problems on which complaints are based are variably reality-based and variably modifiable. Some patients display chronic complaining as a core, distinguishing feature. Based on clinical observations enhanced by selective narrative literature review, the authors delineate and differentiate four groups of patients: 1) situational complainers; 2) chronic complainers due to unidentified medical problems; 3) mood-induced chronic complainers; and 4) personality-driven pan-dimensional chronic complainers.
An example is provided of a perplexing 60-year-old patient who responded to a request for a chief complaint by unleashing a litany of sufferings beginning with a mournful recitation of numerous aches and pains that encompass an area from the top of the head down to the toes. The mix included psychological agonies-anxieties, worries, insomnia, depression, tearfulness, regrets, resentments, grudges, envies, and hurt feelings. Numerous problems were enumerated concerning ungrateful sons, back-biting daughters-in-law who poisoned grandchildren's minds, and a passive-aggressive landlord. The most bitter tirade was reserved for a late spouse who died five years previously, leaving the patient ill-equipped to handle many demands of daily living. All woes were compounded by financial insecurities and frustrations with doctors, pharmacies, and insurance companies. The overall affect varied from bitterness to whimpering to hopeless resignation. Strategies for managing those four groups of patients begin with careful, detailed assessments, including ascertaining reality-based and patient contributions to their complaints. Management approaches that can call upon an array of specific tactics should be formulated according to patient-centered particulars. Sources of countertransference reactions should be identified and addressed. Multiple questions remain and merit further research.