Practice Management Blog

9 Tips for Dealing with Difficult Patients

We’ve all experienced a patient where, no matter what you do, you can’t seem to please them. But there are so many factors that might be influencing their attitude. Maybe they’ve tried a similar service in the past and not had results, or it could be that they’re in pain (either physical or emotional) which makes it more difficult for them to engage constructively. And all this is probably heightened by underlying COVID-related anxiety.

It’s a well-known fact that engaged clients are going to get the best results from their sessions, (and they’re also the ones that will help you grow your practice through word-of-mouth). This means that, as a healthcare practice owner, you need to equip yourself and your team to deal with difficult patients proactively and make it easier for them to engage productively with their care plan.

So, what can you do if you find yourself in a difficult situation with a patient?

1. Identify Difficult Patients

We’re all human, and just because someone is having a bad day, it doesn’t necessarily mean that they’re a difficult patient. They may have a legitimate frustration with the way that you’ve handled a situation, or they might be dealing with something personal that happened that morning.

Difficult patients are different. They may be consistently rude to your team, question your approach regularly thinking that they know better than you, constantly ask for special attention such as after-hours treatment and free phone consultations, have difficulty accepting when you say no to yet another request or nit-pick on invoice items.

Difficult patients come in all different forms so, rather than trying to categorise them so you know how to deal with them, you can usually go with your gut. If you sense yourself becoming anxious or stressed when you see their name on the appointment list, or if your admin assistant with the usually-sunny disposition has something to say about them, you can be reasonably sure that you’re dealing with a difficult patient.

The thing to remember here is that difficult patients come at a high cost. They have an impact on your bottom line because they are more likely to dispute invoices, pay late, not pay at all, contribute to staff turnover, cause stress-related health problems, and they can even harm your reputation.

2. Stay Professional

Stay calm at all costs. This might not come naturally to you, but it’s essential to remain professional even if the relationship between you and a patient deteriorates. Always seek to de-escalate the conversation and if you feel yourself becoming angry or emotional, ensure that there is someone who can step in to mediate the situation. Where possible, avoid engaging with the patient in front of an audience.

Watch your body language when you communicate with the patient because your body will tend to communicate more about your emotions than your words do. You may feel angry when these situations arise, so, take a deep breath in, acknowledge how you feel, and you’ll be able to control your words, tone and body language better, and the outcome of the interaction will likely be better as a result.

You can also equip your employees with phrases that can be used to acknowledge, but not provoke, a patient’s dissatisfaction. It helps to remember that difficult conduct is almost always a response to an underlying issue, and if you are prepared to address the issue with care and empathy, it will often defuse the situation. It can help to use non-confrontational phrases such as:

“I can see that you’ve been waiting a while for your appointment. I’m sorry for the delay and want to reassure you of our commitment to each patient as sometimes unforeseen circumstances arise that are beyond our control.”


“I can see that you are finding the appointment stressful. I’d like to find out more about your experience and see if there are any changes I can make to improve next time.”

3. Set Clear, Realistic Expectations

We asked the Power Diary community for their top tips, and suggestions included setting clear and realistic expectations.

These are the top three:

  • Have written agreements for all patients with terms/conditions of treatment (Pro Tip: you can use Power Diary online forms for this)
  • Have clear processes for staff to follow to provide consistent service
  • Set boundaries and manage treatment expectations

The approach that you use to treat difficult patients is no different from how you would approach most relationships. People respond better when they know what is expected of them, and what they can expect from you. So, the first step in developing a positive relationship is to set expectations of what you need from them in terms of participation, how they engage with the therapy, as well as practical considerations such as arriving five minutes early for an appointment and the payment procedure.

From your side, you need to communicate how you will help your client achieve their goals by developing a comprehensive, custom treatment plan. Explain to them why you’re following this plan and clearly demonstrate how their involvement in the process is integral to its success.

4. Connect and Collaborate with Your Patients

Communication is a two-way street, and your patient needs to be able to voice their concerns in a safe environment. Ask for specific examples, ask follow-up questions and acknowledge that you hear and understand their issues, whether they’re real or imagined.

Healthcare is evolving where providers are no longer authoritarian figures who hand down a treatment protocol to be followed. Instead, patients want to be involved in the decision-making process and have input into how their health is managed. The importance of this has been highlighted by Thomas Cha, MD, MBA, assistant chief of surgery at the Orthopaedic Spine Center at Massachusetts General Hospital, and an instructor at Harvard Medical School, who found that “shared decision making did not just result in better patient experience ratings but also improved patient outcomes.”

If this is an unfamiliar approach for you, it can be helpful to think about the process as a partnership. You’re bringing your skills and experience to the party, and they’re bringing their understanding of their own body based on years of experience too.

To engage your patients in their healthcare journey, you might consider checking in with them between appointments, sending through encouragements, or sharing relevant content that might be helpful for their condition. Practice management software can help with this to some extent as you can set reminders to call clients or send reminder SMS according to a schedule.

5. Be Empathetic

Most difficult patients are responding to something. Maybe they sat in the waiting room for 30 minutes waiting for you, and you didn’t even acknowledge the inconvenience. Or it could be that they’re scared of the treatment and respond to that fear by lashing out. It might even be that they’ve had a similar therapy experience before that was ineffective or unpleasant.

According to Healthline, anger is a symptom of an underlying issue: “Many things can trigger anger, including stress, family problems, and financial issues. For some people, anger is caused by an underlying disorder, such as alcoholism or depression. Anger itself isn’t considered a disorder, but anger is a known symptom of several mental health conditions.”

Having empathy can go a long way to helping you stay calm and in control. And the best place to start is by asking questions before you react to a statement – take time to understand their issues, ask questions and seek to come to a resolution together. This way of dealing with difficult patients communicates that you care and are actively committed to finding a solution because, in all likelihood, their conduct stems from something completely unrelated to your appointment.

6. Offer Solutions

This isn’t about allocating blame, and it’s not about making an apology if you aren’t in the wrong (and you often won’t be). Instead, the focus is on finding a solution to your patient’s problem, without losing your temper or raising your voice.

If you or someone in your practice has made a mistake, admit to it and explain to the patient how you will address the situation and your plan going forward.

If the patient is at fault, take the time to point out the terms of the agreement, and offer suggestions that will allow both parties to move on.

Often, miscommunication is at the root of the issue, and this can easily be rectified by giving the patient options so they can choose what works best for them, whether it’s a regular phone call or a monthly email check-in.

7. Know When to Walk Away

We’re not talking about a patient who is having a bad day (that happens to everyone), or someone that is apprehensive about your therapy (or feeling anxious in general). Unfortunately, sometimes, even if you’ve done your absolute best (and tried every trick in the book), you can’t satisfy a patient. In cases like these, it may be impossible to resolve a situation with a patient who is consistently rude, confrontational and antagonistic.

If you’re not able to make progress in their treatment, or if they’re abusive towards your staff members, you must feel comfortable with the idea of terminating the therapy. When this happens, you should communicate to your patient in writing that you’ll no longer see them due to a breakdown in the relationship. Keep the letter polite and concise, and offer to send through a copy of their treatment notes to their new provider when they send the contact information through.

8. Learn from the Experience

When you have the benefit of a few days to calm down, take a step back and objectively consider the situation. Ask yourself questions about why the issue arose, could you have prevented it, and are there things you need to do differently to prevent it from happening again?

It may be that no amount of jumping through hoops would have helped. But, in many cases, there could be simple adjustments to your internal workflows or communication processes so that the same thing won’t happen again.

9. Get Proactive

If we lived in a perfect world, you’d be able to sense potential conflict situations before they arose so you could get ahead with a proactive solution. While that’s not reality, you can keep an eye on the general perceptions of your patients.


Why not ask them?

Ask for feedback

If you see a patient regularly and you get feedback about their treatment experience, you have an opportunity to improve. A difficult patient may raise an issue with you directly, but it can help to be proactive about getting input. A great way to do this is to send a satisfaction survey right after their appointment. See how to implement it here.

Respond to feedback promptly

As soon as a patient raises an issue with you, make it a top priority to acknowledge them and take steps to sort it out. In essence, this comes down to collecting feedback and acting on it. A patient who isn’t satisfied may choose to change providers, stop receiving care altogether, and they may even share their experience with friends and family, or online.

When you know where a patient is coming from, it’s easier to respond with empathy, and you’ll have a much better chance of resolving the underlying issue. That’s why the nine tips that we’ve outlined above are so powerful. By proactively providing your patient with information, involving them in the treatment plan, and taking feedback on board, you’ll be well-equipped to respond to a situation where they become upset. When dealing with a difficult patient it’s important to take a deep breath and try to be empathetic, remain professional and in control, and if the situation can’t be resolved in a way that works for both you and the patient, then you need to be brave enough to walk away.

Why not create a short checklist in your Practice Operations Manual and share this with your staff? That way, you can easily be reminded of how best to deal with these situations as and when they arise.

This article was originally published in 2020 and has been updated for comprehensiveness and accuracy.

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