Difficult patients can hamper diagnosis, make treatment harder and infringe on clinical time constraints so that the patient schedule is virtually thrown out of the window.

Types of difficult patients tend to fall into three main categories: patients who have difficulty communicating the problem for which they are seeking treatment; patients who fail to comply with the clinician’s recommendations; and patients who become angry and abusive.

All of these patient types come with their own set of problems and frustrations. Patients who have difficulty communicating patient history and symptoms are often hampered by language – verbal or otherwise – or mental health barriers. In both instances efforts should be made as far as is possible to enable communication. Patients who fail to comply with the clinician’s recommendations and treatment plans can be a huge source of frustration. Lack of compliance has health implications for the clinician. It’s important to understand the reasons for a patient’s lack of compliance before rushing to judge or condemn a patient’s decision. Failure to follow the treatment plan may stem from issues of affordability, inability to see the benefit of treatment, lack of comprehension in regard to the treatment plan, or religious barriers to treatment.

Angry or abusive patients usually behave inappropriately for a reason, so making the effort to understand the reasons for hostility can help to resolve the problem and turn the difficult patient into a reasonable and compliant one.

Strategies for dealing with difficult patients are necessary for the benefit of both the clinician and patient and are useful to keep in mind so steps can be taken to avoid turning a difficult patient into an escalating difficult situation.

1. Control Reactions
Try to hold back immediate reactions to patient behaviour so that you can respond thoughtfully to patient concerns without appearing judgemental or adversarial. Immediate reactions that show the frustration you are feeling will have a negative impact on the patient relationship and will not help to penetrate the barriers that the patient has developed in regard to treatment. Try to listen to the patient until they have said everything they want to say; this will allow the patient to fell heard and your responses to identify underlying reasons for patient behaviour so that you can treat the problem. This may include identification of the need for a translator, family member or carer to be present at the appointment to aid communication, reveal the underlying reasons for lack of compliance to treatment strategies, or help to ease a patient’s frustration that may lead to hostile situations.

2. Remain Empathetic
A friendly and understanding attitude will make patients feel more relaxed and comfortable discussing problems they are having with the treatment plan. Patients with communication difficulties will feel reassured that you are taking steps to ensure that you understand their needs and that they understand how to manage their conditions. Empathy can also aid communication so that problems are resolved before a patient becomes angry or abusive – usually a result of frustration and a feeling of being misunderstood.

3. Show Respect
Demonstrate to the patient that you respect their dignity by asking questions that allow them to explain problems without feeling criticised. No matter how insignificant the condition is to the practitioner, it may seem incredibly significant to the patient, so treat every condition seriously and with respect; if the patient thought their problem was insignificant, they wouldn’t have booked an appointment in the first place. Language can be an excellent tool to allow the patient to feel that their opinion counts. Invite the patient to explain why they are having trouble following the treatment plan or what you can do to ease their frustration. By being respectful in your offer to help solve the problem, patients will feel understood and will be more likely to communicate effectively and openly, without resorting to anger, and are also more likely to become compliant with future treatment strategies. Increasing understanding and allowing the patient to become more involved in their treatment plan can empower the patient and remove vulnerabilities that may be a cause of difficult behaviour.

4. Body Language
Using the right body language can go a long way to showing respect and understanding, while the wrong body language can seem hostile or disrespectful. Never cross your arms, as this action comes across as closed and may give the impression that you aren’t open to hearing what the patient has to say. Be sure to make eye contact and nod to show that you are following what a patient is saying and that you are listening to their explanation of symptoms, problems or barriers to treatment. Follow that up with questions to show that you have listened and understood the problem.

5. Scheduling
If you know a patient is likely to be difficult, try to schedule extra time for the appointment so that the patient has your full attention and you aren’t stressed about the next appointment, which can give the impression that you are dismissive of the patient’s problem. Take your time and a better outcome will be achieved and will hopefully lead to an improved ongoing clinician-patient relationship so that the extra time allowance will be a one-off. In cases where the difficult patient is a new patient, try to look at reasons why patient has booked the appointment – if they have been referred following failed treatment elsewhere this can give an indication of patient behaviour, so you can allow extra time to pre-empt any potential problems.