Patients: 'Difficult,' 'Tough' or Just Misunderstood?

Daniel I. Krell, MD


April 10, 2013

In This Article

More Extreme Situations

Rarely, some patients do have personality issues that make dealing with them difficult or impossible. If your staff have strong reservations about or a strong negative reaction to a particular patient, talk with your staff and validate and address their concerns. Supportively inquire about difficult staff interactions with the patient, on the phone and in person.

One of our best office nurses had a terrible history of physical and sexual abuse in childhood. She once walked into the preparation room to start a new patient in the practice, and her alarms went off the chart. She held it together, did what was needed, and before I saw the patient informed me of her feelings. She said she would be unable to tolerate being a room with him again.

The office nurse was fully supported in her reaction, and I monitored the patient's interactions with and the responses of other office staff. Even without knowing the nurse's response, several of the staff were on edge when dealing with that patient, who received appropriate -- but not warm -- responses from them, and eventually stopped coming. I did not inform other staff about the nurse's reaction, because the patient was never reported to have been inappropriate with any of them. Yes, his personal style made some people uneasy, but in the absence of his acting out it was unnecessary (and, I believe, counterproductive) to take any further action.

Support your staff. If you are told that the patient was profane and abusive, inform the patient that such behavior will not be tolerated. Often, I've informed such patients about their effect on the staff and how inappropriate the behavior was and have gotten sincere apologies, which I conveyed to the staff. On a couple of occasions, the patient also apologized to the staff members when checking out.

Encourage your staff to also give the patient the benefit of the doubt. Tape a Q-tip® under each reception window, where the staff member sees it but the patients do not. Let the staff know that the Q-tip is to remind them to "quit taking it personally"; the patient's behavior could reflect any number of factors. We always told our staff to announce the end of the conversation if it became abusive or profane, and then end it. These interventions gave the staff a sense of control and avoided some difficult interactions with patients that could have otherwise escalated. 

Over 20 years, I fired very few patients. Because I practiced in a rural area where the next closest practices were 10-15 miles away, there was motivation on both sides to work things out. In most cases with patients in tough situations who had undesirable behaviors, we eventually crafted reasonably healthy relationships; many of these developed into very warm relationships, and we would laugh about our early interactions.