How to Manage Difficult Patients

Patient interactions can go sour at any time, even for the best physicians. Often, it’s out of your control, but you have to do your job regardless of the person’s behavior or feelings.

Learning how to manage difficult patients is not always taught in professional education. Even if you have learned about it, putting that knowledge into practice in the moment can be challenging.

With that in mind, we’ve put together a guide to help you with managing and communicating with difficult patients.

What Causes Uncooperative Patients?

Patients may be disgruntled for many reasons, ranging from frustration over wait times to anxiety about their illness. Some of the most common reasons a person may be “acting out” include:

• Miscommunication with health professionals
• Unrealistic expectations
• Fear, anxiety, or somatization
• Grief
• Language barriers
• Mental health conditions
• External distractions or stressors (e.g., family members, noise, or lighting)

While it may seem personal, it’s typically not. Often, patients are upset by factors beyond your direct control, though there are exceptions.

That said, it’s crucial to know the signs that an individual may become disruptive or violent. Examples include:

• Change in mood or personality
• Unusual behaviors like clenched fists, facial redness, or excessive sweating
• False statements or accusations and paranoia
• Belittling or demanding language
• Verbal threats

If you notice these characteristics, it’s important to engage in de-escalation tactics as quickly as possible.

5 Strategies for Dealing With Difficult Patients

Working through challenging patient interactions is part of being a healthcare professional. However, having a few strategies in your toolbox makes it easier to respond appropriately in these scenarios.

Although there are many ways to handle challenging interactions, here are five strategies to keep in mind:

1. Active Listening

Active listening is a well-known communication strategy, but putting it into practice is often easier said than done. With short appointments and packed schedules, it’s easy for patients to feel like they’re not being heard. That’s where active listening comes into play.

To ensure that the person knows you are paying attention and care about their health, you should:

• Make eye contact
• Nod
• Paraphrase their concerns
• Validate their feelings

These efforts show empathy, which may improve a patient’s trust in you.

2. Shared Decision-Making

In some cases, patients may act out because they feel like you are not giving them an active role in their care. Shared decision-making techniques can help reassure them that you care about their values and goals, too.

Explain to the patient that you share the same goal as them, but it’s your job to make treatment recommendations. Be willing to explain why you’re making these suggestions and answer any questions or resolve concerns.

3. Be Supportive and Empathetic

Although being supportive and empathetic seems like a given, it can be more difficult with uncooperative people. However, it’s imperative to find ways to connect with the person when possible.

Here are some ways physicians can show compassion, even when dealing with combative patients:

• Reassure the person that you’re listening and respect how they’re feeling
• Reiterate that you’re going to try your best to help them
• Determine the underlying cause of their agitation (e.g., anxiety about test results or worry about cost)
• Explain how your treatment recommendations would alleviate their concerns
• Offer choices during times of stress, such as asking the person where they would like to speak with you
• Ask patients about ways you could improve future interactions

When interacting with irritated, anxious, or aggressive patients, it’s best to use a firm but level voice. Keep your posture relaxed and stance open and welcoming.

4. The CALMER Approach

One strategy for dealing with challenging patients is the CALMER approach. Each letter corresponds to a different element in the approach:

• C — Catalyst for Change: While you can’t control the person’s behavior, you can control your own reaction. As a physician, it’s your responsibility to help patients move toward positive change.
• A — Alter Thoughts to Change Feelings: To control your reaction to a difficult situation, you must change your thoughts. Identify what you’re feeling and how it influences the doctor-patient relationship. Consider why the person may be acting out, which can cultivate empathy.
• L — Listen and Make a Diagnosis: The previous steps should help you navigate your feelings, enabling you to better listen to the person’s concerns. By separating your feelings from the person’s condition, you’re more likely to make a correct diagnosis.
• M — Make an Agreement: Explain the proposed care plan to ensure the patient understands what’s to come. By coming to this agreement, the person may recognize the conscious choice(s) they’re making for their health.
• E — Educate and Follow Up: Provide education when necessary and assist the person in setting realistic goals that lead to mutually desired outcomes.
• R — Reach Out and Discuss: Once the interaction has ended, check in with yourself. Understand that stressful conversations can take a toll, and seek help if necessary.

Use the CALMER approach as a baseline for guiding challenging patient interactions.

5. Motivational Interviewing

Another strategy many healthcare providers use is motivational interviewing. There are four components to the process:

1. Asking open-ended questions to ensure a shared understanding
2. Affirming the individual’s priorities, health goals, and efforts so far
3. Restating any opposing priorities or values the patient has to help them determine what they are willing to commit to
4. Summarizing decisions and treatment plans so you both have the same understanding

Motivational interviewing is beneficial for those who feel left out of treatment planning. These steps help you show empathy and understanding, which may make it easier for patients to express themselves.

Learn the Best Ways of Communicating With Difficult Patients

Continuing medical education (CME) helps you stay up to date with the latest best practices in the industry. With topics ranging from new technologies to doctor-patient relationships, there’s plenty to study with CME.

Browse our upcoming events today to get started.