How To Deal With Difficult Patients In Healthcare?

How to deal with a difficult patient

1. Create a suitable environment.
2. Listen carefully.
3. Give an empathetic response.
4. Identify the cause of the problem.
5. Ask for help.
6. Repair the relationship.
7. Maintain professionalism.
8. Use appropriate nonverbal communication.

More items

How would you handle a difficult and angry patient?

No matter what field you work in, these tips will help you keep your cool when patients take their frustrations out on you. Even patients who are normally calm may quickly reach the boiling point when illness threatens their health, mobility, and independence.

Pain and fear can lead to increased stress, anxiety, and frustration, which can result in anger and even loss of control. But do you know how to spot your patient’s anger early and defuse it? For guidance, read on. These tips will help you get control of the situation and hopefully reduce the likelihood of legal action down the road.

Look for the signs There are signs that indicate a patient’s emotional state is deteriorating. Look for changes in body language, including a tightened jaw, tense posture, clenched fists, fidgeting, and any other significant change from earlier behavior.

1. A talkative person, for example, may suddenly become quiet.
2. Observe the patient for additional signs that his temper is rising.
3. Is his voice raised? Is he demanding excessive attention? If you detect any of these warning signs, you’ll need to act fast to help the patient vent his feelings in a productive manner.

Start by spending extra time with the patient. Although you might be tempted to spend less time with him, doing so only increases your risk of liability. Ignoring his complaints or, say, rushing him may prove detrimental to his care. And if something goes wrong, dissatisfied patients are more likely to sue.

If, for instance, you work in a healthcare facility, take time to ensure that he is thoroughly familiar with his plan of care and the rationale behind it. Review the care he’s received so far, the progress he’s made, and how long his recovery should take. Show empathy Some patients won’t be soothed by your extra attention and may become belligerent, demanding to know such things as, “Why can’t you start my therapy now?” “Why isn’t my treatment working?” or “Why aren’t my medications ready yet?” Your calm approach in answering such obviously loaded questions can prevent anger from turning into a behavioral crisis.

Rather than becoming defensive, you’d be wise to respond calmly to the patient and treat him with respect. If a patient is uncooperative, try to identify the underlying reason. A patient who balks, for example, when a PT suggests replacing one exercise for low back pain with another may actually be anxious about an upcoming procedure or the results of tests.

1. After you hear him out, reassure him that you take his concerns seriously.
2. Empathize with him, saying something like, “I understand how upsetting this must be for you.” Be sure, however, to calmly explain the consequences of his refusal.
3. In this example, the PT would need to elaborate on the reason for the new exercise and explain that the patient’s unwillingness to cooperate will delay his recovery.

If, on the other hand, the problem is an administrative one-such as having to wait too long to see a healthcare provider-speak to the appropriate person about scheduling a time that’s less likely to involve a wait. Keep your cool If a patient is angry enough to verbally abuse you, remain calm and professional.

Keep some distance between you and the patient and do not respond until the verbal barrage is over. When it is, speak softly and call the patient by name. For instance, an EMT confronted by a patient screaming that he doesn’t want to be touched should listen quietly until the patient is done. He can then try to soothe the patient, saying something like, “I know you’re scared, Mr.

Smith, but I just want to take your blood pressure and make sure you’re okay.” That approach may calm the patient enough to allow for a more thorough examination. Should a patient become irrational, he’s likely to try to intimidate you. He may say things like, “I’m calling my lawyer” or “I’m going to sue.” Trying to justify the situation or defend your actions will only make things worse.

1. Use active listening instead: Paraphrase back to the patient what he’s already told you, while at the same time identifying the real feelings behind the words-fear or helplessness, for instance.
2. Eep your statements short and simple.
3. Continue to treat the person with respect and show accepting body language by letting your arms hang loosely at your sides rather than standing with your hands on your hips or with your arms crossed.

If the patient “blows up,” he has lost control and is so irrational he will no longer hear what you say. As in dealing with a child’s temper tantrum, your reaction may determine exactly how long the fireworks last. Keep your cool and don’t be manipulated by the patient’s anger.

Never get angry yourself or try to set limits by saying, “Calm down” or “Stop yelling.” As the fireworks explode, maintain eye contact with the patient and just listen. Try to understand the event that triggered the angry outburst. When the person has quieted down, acknowledge his feelings, matching your words to his level of anger.

Express regret about the situation, and let the person know you understand. Try to find some point of agreement, perhaps acknowledging that his complaint is a valid one. Ask for the patient’s solution to the problem. Use phrases like, “Can you tell me what you need?” or “Do you have some suggestions on ways to solve this problem?” End the conversation by trying to reach an acceptable arrangement.

Offer options by saying, “Here’s how we could handle this.” If the patient threatens you physically or you fear for your safety, don’t hesitate to contact security or the police. For more immediate assistance, consider establishing a code phrase that indicates when a staffer needs help. Regardless of the extent of the patient’s anger, documenting complaints-as well as attempts to resolve them and the results of each intervention-can ward off frivolous claims or help in your defense if a lawsuit proceeds to trial.

If applicable to your line of work, note administrative complaints in an incident report. Document clinical complaints in the patient’s chart. Dealing with difficult patients will always be a challenge. But your finesse in defusing and managing anger will keep the focus on getting the patient healthy and protect you from unwarranted legal action.​

How do you deal with a patient who is causing trouble?

Try taking a few deep breaths or even leaving the room to create some space. Once you feel level-headed, acknowledge the patient’s grievances. Apologize without admitting fault — similar to how you would respond to a negative online review — and ask how the patient thinks the matter would be best resolved.

How do you handle a difficult patient interview question?

As a nurse, it’s important to have compassion in patients. When asked this question, consider giving an example of a time when you encountered a difficult patient and helped to improve the patient’s outcome. Make sure to mention if you provided extra resources that helped make the patient more comfortable.

How do you approach a patient who refuses treatment?

Background A core aspect of American bioethics is that a competent adult patient has a right to refuse treatment, even when the physician believes that the treatment would be beneficial. At such a time it is easy to either question the patient’s capacity to make the decision or try even harder to convince them to change their mind.

The empirical literature – both in decision making and in medicine – suggest that this is a false dichotomy and that there is a third more productive way to proceed. The method described below is applicable to all situations of conflict between clinicians and their patients/families; the astute reader will note the similarity between this approach and that presented in Fast Fact #26, The Explanatory Model, designed to assist mediating conflicts that arise in cross-cultural encounters.

Clarify Decisionality Distinguish between patients who cannot understand the medical situation (and thus may lack decision making capacity) and those who understand your viewpoint but do not agree with it. Ask, I have talked with you about the medical problems you are facing and possible treatments for these problems.

Just to make sure we are on the same page, can you describe for me the medical problems you are dealing with now? Can you also describe the possible treatments we have discussed? (See Fast Fact #55 for more on decisionality.) Understand their story Try to understand the patient/family’s story before you try to change their mind.

This means suspending your attitude toward their decision and as openly and non-judgmentally as possible, understanding the reasons for their decision. This can be done by asking, Tell me more about your decision – what leads you to this conclusion? Validate concerns Often when we try to convince others of our position, we forget to acknowledge the reality of their concerns.

1. This makes them feel unheard and under appreciated.
2. More effective are responses which first let the person know they were heard (So you are concerned that if you have surgery you will X) or that normalize their concerns (It is not that unusual for people to be afraid of XX) before you respond to these issues.

Explore fears Fears are stronger motivators than positive inducements. Try to understand your patient/family’s fears/concerns with your plan of action; you can only address their fears if you understand them. Ask, Can you tell me if there is something about this decision that frightens you? Establish a win-win position If the patient’s concern is the lack of control in the hospital and your concern is her/his health if s/he leaves the hospital, what can you do to provide more control in the hospital? Negotiate so both of you can achieve what each of you care about the most.

Drane JF. The Many Faces of Competency. Hasting Center Report.1985; 15(2):17-21Stone D, Patton B, et al. Difficult Conversations: How to Discuss What Matters Most. New York, NY: Penguin Group; 1999.Appelbaum PS, Roth LH. Patients who refuse treatment in medical hospitals. JAMA.1983; 250:1296-1301.Jones RC, Holden T. A guide to assessing decision-making capacity. Cleve Clin J Med.2004; 71:971-5.

Version History: This Fast Fact was originally edited by David E Weissman MD.2nd Edition published July 2006; 3rd Edition May 2015. Current version re-copy-edited April 2009; references updated; copy-edited again May 2015. Fast Facts and Concepts are edited by Sean Marks MD (Medical College of Wisconsin) and associate editor Drew A Rosielle MD (University of Minnesota Medical School), with the generous support of a volunteer peer-review editorial board, and are made available online by the Palliative Care Network of Wisconsin (PCNOW); the authors of each individual Fast Fact are solely responsible for that Fast Fact’s content.

• The full set of Fast Facts are available at Palliative Care Network of Wisconsin with contact information, and how to reference Fast Facts.
• Copyright: All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/).

Fast Facts can only be copied and distributed for non-commercial, educational purposes. If you adapt or distribute a Fast Fact, let us know! Disclaimer: Fast Facts and Concepts provide educational information for health care professionals. This information is not medical advice.

• Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published.
• Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources.
• Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling.

Accordingly, the official prescribing information should be consulted before any such product is used.

Can I tell a patient they are being rude?

Answers from medical ethics – Patient provocations are bound to happen from time to time, but professionalism is always the expectation for physicians. Also, while clinicians are often on the receiving end of inappropriate language, some patients also report disrespectful treatment from doctors.

Guidance from the AMA Code of Medical Ethics addresses the question of unacceptable from either side in Opinion 1.2.2, “.” “Disrespectful or derogatory language or conduct on the part of either physicians or patients can undermine trust and compromise the integrity of the patient-physician relationship.

It can make members of targeted groups reluctant to seek care, and create an environment that strains relationships among patients, physicians, and the health care team,” the Code of Medical Ethics says. “Trust can be established and maintained only when there is mutual respect.” The Code says that in their interactions with patients, physicians should:

Recognize that derogatory or disrespectful language or conduct can cause psychological harm to those they target. Always treat their patients with compassion and respect.

If a patient “uses derogatory language or acts in a prejudicial manner only” and refuses to “modify the conduct,” the Code says, then “physician should arrange to transfer the patient’s care.” Dr. Cowan’s commentary captures, in practical terms, how that guidance plays out in face-to-face encounters with patients: “My message to whomever I am correcting is always the same, ‘I care about you as a person, but I will not tolerate offensive behavior.

How do you handle stressful situations with patients?

Be an Excellent Listener – One of the best tips for how to comfort stressed patients is to simply hear them out. By taking the time to seriously listen to your patient’s fears and concerns, you’re telling them that you genuinely care and want to make it better.

How do you approach a patient with a difficult diagnosis?

Explain the difficulty and try to find common ground – Try to put the focus on the “elephant in the room”, i.e. verbalise the problem in a kind yet clear manner and find some common ground with the patient. Establishing common ground is a key point in reducing any tension that may have arisen.

1. The patient needs to have confidence and actually recognise that you are listening to them.
2. For example, you can show understanding towards the patient’s anxieties and worries, and reflect this understanding back to the patient.
3. This shows empathy, and may help the patient feel more comfortable, let off some steam and voice any underlying problem or concern that contributed to the challenging interaction.

On some occasions during these “de-escalation” conversations you may realise that there is an alternative explanation to the patient’s feelings and this may have increased their anxiety or fear.

How do you describe a difficult patient?

Abstract – Difficult patients are defined as those who elicit strong negative emotions from their physicians. If not acknowledged and managed correctly, these feelings can lead to diagnostic errors, unpleasant confrontations, and troublesome complaints or legal claims.

How do you talk to a frustrated patient?

You can try to ease the angry patient’s distress with these strategies: –

Appear calm, respectful, self-controlled and confident. Don’t take the patient’s comments personally. Approach in a warm, friendly manner. Avoid confrontational body language (e.g. crossed arms, standing too close). Be careful with the use of touch – it may be interpreted as a threatening gesture. Find out what the problem is from the patient’s point of view. Use active listening, and show you are listening, e.g. by nodding. Don’t interrupt, and give the patient time to clarify their thoughts. Ask reflective questions, putting their statements in your own words to clarify your understanding – e.g. You need to see a GP as soon as possible, is that correct? Use a series of ‘yes’ questions – it’s hard to remain angry with someone who keeps agreeing with you. Speak softly and clearly, using simple language without ‘talking down’ to the patient. Give clear messages showing that you want to help and you understand their point of view. Don’t try to provide solutions until the patient has calmed down, so they can listen and be more rational. Give control to the patient, e.g. What I would like to do/ discuss/consider now is XYZ, is that alright with you? Ask the patient to list possible solutions. Don’t promise what you can’t deliver. Be considerate, e.g. offer them a glass of water

How do you tell a patient you don’t want to treat them?

Some patients don’t want to hear it, they just want their unreasonable request accepted. Here’s how to say no. As doctors, we have all heard unreasonable patient requests. Some are so outrageous that legends are passed down the ranks. For the most part, we try to work as a team with our patients to reach the best treatment plans for them. Yet, a line must be drawn so we do not give in to nonsensical requests.

It is never easy to be the bad guy. But, we are not customer service representatives, rather professionals who possess an extensive training. If a mechanic told you that you did not need your brakes replaced, would you demand otherwise? Saying no to unreasonable patient requests: • Just say no Don’t be vague.

If you are not going to give in to something a patient is asking, say so. Don’t let them believe you may change your mind. If a patient is requesting an opioid pain medication but you do not feel that is the best treatment for them, tell them you are not going to prescribe it.

1. Don’t give them “just a few” and tell them you are not comfortable prescribing it.
2. They will be back and the same scenario will play out.
3. Explain why you are saying no.
4. To just refuse a request without explanation is rather cruel.
5. For example, I sometimes will have patients ask me to send a prescription under another family member’s name for insurance reasons.

I explain to them doing this would actually be considered insurance fraud and we can both get into trouble for doing this. When most patients understand why, they completely understand and do not ask me again. • Offer alternatives. In the above example, while I cannot write a prescription under another person’s name, I can try to find cheaper generic medications that the patient may be able to use instead.

• For the patient in pain, instead of just saying no to a request for certain pain medications, I can refer them to a pain management specialist.
• Don’t argue.
• We need to keep in mind that when patients see us they are often at their worst.
• We need to be empathetic and allow them some room to vent.
• We all know the healthcare system is not the easiest world to navigate these days.

But if the patient becomes overly aggressive, we also need to know when to say enough, we are not discussing the matter further. Often, I see patients who want to argue over their bills. I do not engage in these discussions and immediately refer them to my biller.

• I explain that I rather focusing on their medical needs without financial distractions and they can work out the issue with the appropriate staff.
• Many patients simply ask not to pay what they are responsible for.
• It is hard for me to explain why I need to be paid (contractual obligations, overhead expenses, etc).

These conversations never go well and avoiding them in the first place is the best solution. • Be kind. A patient requesting an opioid medication may be in severe pain. They are often made to feel like drug dealers when they are seeking help for their medical problem.

• Even if we plan not to prescribe a certain medication, we need to be kind about it.
• Be consistent.
• If you one time you give in to one patient’s request, such as to write off their copays, you will find others coming to ask the same thing.
• Patients talk to each other.
• When you write it off for one and not the other, people will get angry.

• Understand why a patient is making a request. A patient may come asking for a brain MRI for a trivial headache. While you think this test is unreasonable, the patient may be lying awake every night for weeks afraid that they have a brain tumor. When you understand why they are making a request, you can address the underlying reason.

In the aforementioned example, you can explain why their symptoms do not suggest a tumor and they do not need the study. Just saying no does not serve this patient at all; they are still left with their fear. • Set policies up front. It is much easier to tell a patient it is the policy of your practice, for example, not to prescribe certain medications.

Make sure your staff is on board with these policies and everyone is telling the patient the same information. As doctors, we must remain professional in the face of anything we may encounter in the exam room. It is our responsibility. And while we may think it completely unreasonable, we must remember that the patient may not.

How do you communicate with an angry or anxious patient?

Establish open communication so that the patient is comfortable asking questions. Show respect and an interest in them as a person. Do not assume that there are no questions, even if they do not ask. An understanding of the situation can help to decrease frustration.