Dealing with Difficult Patients

Encounters with difficult patients, while often unpleasant, are something providers and staff have to learn to deal with as part of their jobs. And, sadly, they tend to pop up fairly regularly. In fact, one study found that 30 percent of patient encounters were rated as “difficult” by responding physician practices. These sorts of negative interactions can be frustrating and demoralizing for everyone at your practice. However, with the right methods, you can reduce the stress caused by difficult patients and improve the outcomes of these uncomfortable situations.

To help our readers, this blog will look at several types of difficult patients as well as offer helpful tips on how to manage them.

The Angry Patient

Probably the most common type of difficult patient you will encounter is the “angry patient.” This person is unhappy, whether or not for valid reasons, with the experience they’ve had at your practice. When this happens, it is important for you to keep one thing in mind—this is not about you. Do not take this personally, as that will only cause you to be confrontational. Remember, it is more than likely something else is going on with the patient that is making them act out with anger.

You can smooth things over and unruffle the patient’s feathers, so to speak, by staying calm and maintaining control of your emotions. Being confrontational or meeting anger with hostility will only cause the situation to escalate into worse territory, such as name calling or threats (see the next section for more on that).

The best way to avoid escalation is to acknowledge the patient’s anger. For example, you might say something like, “I understand you are angry, and I apologize.” Or you could say, “I feel like our communication has broken down and I would like to fix that,” as this will help the patient feel heard and may help them calm down. One thing you should not say is “You need to calm down.” Telling someone to calm down actually tends to have the opposite effect.

While acknowledgements and apologies are a good place to start, they mean nothing if you don’t back them up with actions. Try to offer some method of resolution for the patient. If the patient is demanding something unreasonable, offer a more reasonable alternative that is a fair compromise.

The Manipulative Patient

Next, let’s take a look at the “manipulative patient.” In contrast to the angry patient, the behavior for this type of difficult patient can sometimes be a little harder to recognize. While manipulative patients can take many forms, one common scenario is the patient who is a frequent visitor to your practice, often takes up more time than allotted for the visit and seems to have an endless list of needs. Another example would be a patient who tries to influence providers (often through flattery and friendliness) in order to obtain prescriptions or medications, free products or complimentary services. While they may seem nice on the surface, watch out for ulterior motives. Sometimes, they may even try to use guilt as a weapon to get what they want. Managing manipulative patients can be exhausting, to say the least.

The best initial approach to identifying and addressing this type of patient is to take a step back from interactions with them, allowing you to consider the patient’s agenda and the driving force behind their behavior. Next, consider the patient’s social circumstances. Are they lonely? Are they dealing with unhappiness at home? Do they feel their needs are not being met, for some reason, perhaps due to experiences with a previous healthcare provider?

For manipulative patients, setting boundaries is paramount. Rather than leaving the patient with an open invitation to schedule too many frequent appointments, you should create a clear management plan with a set appointment schedule. This may help to allay the patient’s anxiety or curb manipulative behavior. Offering regular “checkup” appointments or telehealth visits may also help to appropriately space apart this patient’s visits.

Lastly, when dealing with manipulative patients, it is extremely important to document everything in as much detail as possible. This serves two functions. First, the patient can reference your visit notes and thus may not need to schedule so many visits. Second, it will also help you prove that you’ve appropriately addressed the patient’s condition when presented during the in-person visit.

The Threatening Patient

Another type of difficult patient you may encounter is one that is verbally or physically threatening. When a patient’s demeanor is threatening, you will need to keep a level head with clear, quick thinking in order to keep the situation under control. You and your staff must be very cognizant of staying calm and having a relaxed body posture. As with angry patients, getting upset will only make things worse and perhaps even agitate the person even more. Avoid countering threats with your own verbal threats or making gestures that might be deemed as aggressive.

Control the environment by removing the patient from an area where there are other patients or other people witnessing the event. Often, moving them into another space will increase their sense of you being in control of the situation. The safety of the staff, public and the patient should also be considered when relocating them to another area in the office or building.

Once you have regained control of the situation and some resolution has been determined, it is very important to document the events as soon as possible while it is fresh in your memory. If the situation escalates to threats of physical violence, you should immediately contact law enforcement and document the encounter in a police report.

Follow up with your staff is also very important. The event of a patient altercation should be discussed to ensure your staff is comfortable with the resolution. Discussing the event will make sure they understand any way the situation could/should have been handled differently. That way, if this ever happens again, staff will have an understanding of what to do. Once established, this protocol should be discussed and covered in the onboarding process of new staff members and revisited during staff meetings to ensure everyone is on the same page.

Other Things to Consider

Keep in mind that the negative patient behaviors we have discussed in this blog may not have anything to do with you or anything your practice has done. Remember that there are always special circumstances to consider, such as the following:

• Mental illness or mental instability
• Decreased mental capacity or aggressiveness due to degenerative disease (i.e. dementia)
• Life stress that has nothing to do with the situation or events that took place (i.e. financial difficulties)
• Overbearing caretaker or family member pushing a situation onto the patient

No matter the situation, maintain control by removing the patient from an audience. Make sure the space is safe for you, your staff and the patient. Avoid a physical confrontation and remain in control of your actions and demeanor. Stay calm and use reflective questioning. Listen to the patient’s complaints and offer reasonable resolution. A little bit of listening can go a long way. Keep your ego in check and demonstrate real concern. Come to an agreement by being willing to compromise.

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