Those 'Difficult' Patients Whom You and Your Staff Dread

Mark Crane


December 04, 2014

In This Article

Drawing Boundaries With Angry Patients

"Happy families are all alike; every unhappy family is unhappy in its own way." That first line from Leo Tolstoy's Anna Karenina may also apply to the "difficult" patients whom so many doctors and their staffs dread.

There are patients in every practice who seem to thrive on conflict. They arrive at your office with a chip on their shoulder, long lists of symptoms, demands for unnecessary drugs and tests, and an almost brazen refusal to follow your instructions.

How can physicians deescalate potential battles? Experts in the anatomy of doctor/patient relationships say physicians need to set reasonable expectations from the start.

Physicians must be clear about what behavior is unacceptable, such as shouting, name-calling, or threats. Once boundaries are established, apply them consistently, said Richard G. Roberts, MD, JD, professor of family medicine at University of Wisconsin Medical School. Have procedures in place to deal with patients who are abusive to staff. Physicians and staff should document inappropriate behavior in the medical record.

"I have some grumpy old men in my practice who growl at everyone," he said. "You have to let them know what won't be tolerated. I've said, 'Look, Tom, I know you're hurting, and I'll do my best to help you. But I can't have you talking to my nurses that way. We all deserve respect. If you want to be respected, you have to show respect.' Sometimes the patient is unaware of his behavior until you have this conversation."

"Any abusive behavior must be confronted immediately," said Patricia J. Roy, DO, a solo family physician in Muskegon, Michigan. "My nurse practitioners (NPs) are attractive women, and a couple of patients have been a little suggestive with them. I tell them that such behavior isn't appropriate, and I instruct our NPs to do the same. If they feel uncomfortable, they should say so.

"Another boundary issue is request for fraudulent billing, such as asking me to change the diagnosis so that insurance will cover the treatment," she said. "I just won't do it. Period. I tell the patient why I won't do it and suggest he see another physician if he insists."


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