The term is known to physicians everywhere, passed by word of mouth from resident to intern to medical student. Psychiatrist Abbey Strauss described the phenomenon in a 1983 paper: a patient who is “childlike, unreliable, occasionally arrogant, demanding, insensitive, self-centered, ungrateful, non-compliant, and wrongly motivated.” Strauss describes a type of SHPOS who might be called a “difficult patient.” His paper focused on the way physician and patient narcissism create the SHPOS interaction. As a psychiatrist with an interest in antisocial personalities, I would add to his description the words abusive, threatening, racist, misogynistic, and rageful.

Not surprisingly, the SHPOS is often alone in the world. He may have just been released from jail, or his loved ones may have refused to take him in. He may have been fired from his job or banned from seeing his children. On top of that, now he is ill. The SHPOS comes to the hospital in a state of social despair, isolated and unhelpable, and the only person left to absorb his rage is the health care worker who must care for him, no matter how hateful he is.

One doesn’t get called an SHPOS for nothing. Walk the hallways of a hospital in a tough neighborhood and you will see security officers, some of them armed, on every ward. Some patients require two officers to control their violence and threats—and these patients are not under arrest. Patients throw feces and full urinals at staff. They cut themselves with IV needles to express their disgust with the hospital diet. They prey on other patients who are too ill to defend themselves, stealing their cash and even the food from their trays.