Difficult patient issues perplex every provider

Providers report an increased number of problems with challenging patients.

These are the patients, or their family members, who become angry, raise their voices and make up their minds early in the interaction that you are not competent, or you are disrespecting them, or you are only after their money.

Psychological issues

Dealing with these kinds of patients is difficult because one suspects that that are psychological issues involved. It is not always clear how to reassure them that you are doing your best for them. They are as likely to become agitated with your explanations as with their initial complaint.

Some may make an effort to enlist you in defrauding their insurer, to avoid paying their share. This area is hazardous.

Avoiding legal headaches

Unfortunately, these are also the people most likely to file a lawsuit against you or your practice. It is easier for some professionals than for others to fend off these individuals. Though they may be disabled or ill, they nevertheless test your professionalism and your personality, looking for ways to bully you and your staff. On some days, a single patient like this can throw your entire office out of kilter.

You do not want your altercation with this patient to become a legal matter. Many providers stress the importance of maintaining authority in these situations. You assert that the clinic is your place of business, and they are not allowed to throw it into an uproar. You define the boundaries. Do not let people overstep them or cause them to blur.

Now is when you learn the value of having competent, capable staff who can say "no" without antagonizing people.

One approach is to write the patient a calm but clear letter stating that a provider's relationship with a patient is rooted in choice. The patient chooses a doctor he or she trusts, and the doctor wants patients with whom he or she can work. Bad behavior by the patient serves notice that the relationship is not working.

Be sure that you document instances of abusive behavior in writing. If the matter should lead to litigation, you will be glad you kept good notes.

But if you deal with the patient honestly and firmly, litigation - even of a frivolous kind - should be rare.

Hippocratic addendum

Remember that, in most instances, these people are suffering. To the extent you can, strive to be empathic to their complaints. It is not always their fault that they behave poorly.

The worst thing you can do is fire back with your own anger. Perhaps that should be added to the Hippocratic Oath:

Don't take patient misbehavior personally.

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