Paranoid thinking presents in two ways: grandiosity in which the individual feels that they are uniquely gifted or persecution in which they feel they are the target of oppression.
Many injured workers are given data that increase their perceptions of persecution. They are told that panel providers are both lacking in competence and lacking in concern. They receive this misinformation from a variety of sources. It does little to help them and much to increase their anxiety.
However, there is another concern when dealing with the highly distrustful and suspicious patient and that has to do with a concept called _projection._ There are untrustworthy people who then project their own lacking integrity upon others. They accuse others of that which they would do given the opportunity. Knowing that they personally cannot be trusted, they then distrust the motives and intentions of others.
Thus, the patient may be portraying a series of distortions provided him by others, or he may be accusing you of the dishonesty that may be representative of him.
The best management in such cases is to put the burden of the decision back upon the patient: _This is how I do my job; I can see that it does not please you. You can either begin to invest trust in me or can seek care in another office. What will not work, however, is this attitude which you bring to the office. I have the option of treating you, and you have the option of finding someone else whom you may prefer._
Repeated reassurance and repeated subjecting of yourself to attack will not itself calm the patient. You provide boundaries of your practice, limits on what is acceptable behavior and then accept the patient_s decision.