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Managing difficult patients

See also Tips for de-escalating angry patients.

Consider the following techniques and strategies to help manage and improve a difficult patient relationship. 

  • Remind yourself at the beginning and during an exam with a difficult patient to be compassionate and empathetic. Patients may be experiencing difficulties that you are not aware of.
  • Monitor your physical and emotional reactions. Body language or facial expressions can betray your feelings. Learn to recognize any potentially negative physical signs, such as grimacing or crossing arms, so you can adapt as they appear during a patient visit.
  • Keep in mind that patients often take their physician’s actions and statements very seriously. They are often looking for unspoken cues to bring added meaning to what is being said. Also, they may be more attuned to how a situation or conversation “feels” than what was actually said.
  • Maintain eye contact; speak clearly and firmly; and be careful to respect a patient’s personal space.
  • Pay attention if the patient is speaking loudly, using profanity, or otherwise exhibiting growing anger. These behaviors may point to an underlying issue, such as anxiety caused by a family conflict, a possible mental health concern, or complications caused by another illness.
  • Prioritize the patient’s immediate concerns and determine the patient’s expectations for treatment and their relationship with you. Clearly establish expectations, ground rules, and boundaries.
  • Remember that negativity directed at you actually may be meant for others or simply at the overall situation (illness, poor prognosis, chronic condition, lack of family support, lack of financial resources, etc.). You may become a misplaced target of the patient’s frustration.
  • A patient who repeatedly directs angry or emotional outbursts at you is not exhibiting typical or normal behavior. Generally, this kind of behavior is a reflection of the patient’s emotional health, instead of a reflection on you or your skills.
  • The best way to respond to rudeness or hostility is to remain as professional and calm as possible, while still showing appropriate concern and empathy for the patient.
  • Focus on potential solutions, not areas of disagreement. Encourage the patient to propose treatment options; discuss and compare them with your own proposals; and foster a situation where you are working together to solve the patient’s problems.
  • Make every effort to address all of the patient’s questions and concerns before concluding a discussion.
  • Prepare for an upcoming visit with a known difficult patient. Keep care goals in mind, and plan how you will manage the encounter.
  • Debrief with colleagues after a difficult patient encounter. They may have helpful guidance or provide context or other insights into the encounter.
  • If necessary, plan an appropriate response if you think the patient may yell at you, threaten you, or attempt to assault you.
  • A note of caution. If you have any reason to fear physical violence — the patient has threatened you or your staff or if you suspect the patient is carrying a weapon — remove yourself from the area and contact a security guard or the police.
  • If you are the victim of an assault, report the incident to the police and, if applicable, to your hospital’s administration. Document the assault and actions you took in the patient record.
  • Despite your best efforts, a relationship with a difficult patient may not be possible. While a physician should not terminate the patient relationship without first attempting to attain a positive outcome, sometimes seeking another physician is best for both you and the patient.