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How to deal with ‘difficult’ patients: four strategies

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Because patients aren’t always at their best when they arrive at the doctor’s office.

It’s confusing to refer to a patient as “difficult.” After all, patients go to their doctor when they are feeling bad, uncomfortable, or are in pain, so they aren’t always at their best. They can be harsh or abusive to office staff. They may question a provider’s medical judgment. In addition, many patients are embarrassed or ashamed to admit everything to their doctor and don’t always take a provider’s advice. And some physicians think patients can be coined “difficult” when they have multiple comorbidities and are simply tough to manage. In this article, we’ll discuss the most common issues that come up with patients that may make them harder to deal with and solutions that may help a provider.

Here are four ways that physicians can deal with “difficult” patients.

Build a trusting relationship

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Patients want to please their doctor, and they need to know you care about them. Write down little notes about their personal life. How was their trip to Disney? How are the kids doing in sports? Asking personal questions and building a rapport with the patient beyond the presenting issue creates a bond, and if the patient is challenging or pushing back, you can correct the behavior easier if there is a trusting relationship between the two of you. It needs to feel safe for a patient to explain intimate and personal concerns. Create an environment that encourages a patient to be open.

Praise the positive, not the negative

Patients almost expect bad news from their doctor, like they need to lose weight, stay on their medications, stop drinking as much, or exercise more. But sometimes, it’s great to showcase what someone is doing well, especially if you have a noncompliant patient who doesn’t always follow the treatment protocol. If a patient’s blood pressure was improved or a weight loss goal was met, issue praise and recognition! One client of mine used to print out labs that showed improvement and wrote notes like “well done!” and had his nurse mail it to the patient. A personal token of recognition goes a long way toward improved compliance.

Control the narrative as best you can and schedule follow-up visits

Many patients have the ability to derail your entire day, ask endless questions, or feel they can use a 15-minute visit to share their entire life story. You do want to sit down and look at the patient and make him or her feel cared for, but you can’t spend an hour with each one. Encourage the patient to focus on the issue at hand for one visit but perhaps make a follow-up visit to discuss the rest. You can try empathetic phrases about how you value the patient’s time and the time of those in the waiting room and you want to “focus on the most pressing issue” so that it can be dealt with.

Set appropriate boundaries

Patients have a variety of mental and physical challenges, and often they try to push to get antibiotics, narcotics, or treat your staff in a way that’s unacceptable. Don’t be shy about setting boundaries early to avoid bullying behavior. And if they do, don’t be scared to send them a letter informing them that they are no longer welcome at your practice.

Doctors are in the business of helping and healing people. The expectation is that patients should be grateful – not angry, frustrated, and noncompliant. But recognizing, preparing for, and trying to avert those unpleasant encounters will make a better patient experience and your practice more successful.

Amanda Hill is an Austin, Texas-based health care attorney and founder of Guard My Practice, an online video platform for doctors in 15-minute weekly sessions guiding them through complicated subjects with ease, such as contract negotiations, fraud and abuse issues, employment conflicts, the basics of setting up a practice, and more.


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