Let’s talk about how to deal with difficult patients, but I should start by saying, I consider the vast majority of my patients to be a complete hoot to work with.

Sport and exercise medicine patients are usually highly motivated folk, keen to do anything it takes to get them better. Spending time with them means I get to geek out on tech talk about bikes and running regimes. In other words, I mostly love ‘em.

Very occasionally, I meet a patient who doth  not make my heart sing. This isn’t a common scenario, although I know for some of my Private Practice colleagues, this can sometimes feel like the norm.

Why do we find some patients ‘difficult’?
Well, we could take the somewhat self-righteous high ground and declare that no patient is ever a problem. They are merely patients with ‘different needs’.

Yeah right.

I’m willing to bet most of us would confess to at least one soul-sapping, angry, manipulative, non-compliant, and downright obnoxious individual, who disrupted the entire clinic, keeping all of the lovely patients waiting. So how can we limit or best handle these hopefully rare interactions?

Here are my suggestions for how to manage difficult, tricky, or angry patients
Shut up and listen.
When confronted with a patient who is generally angry at the world, but who chooses to direct it at you,  pause and listen.

It goes without saying that the most important thing for a patient, is to be heard. They want someone to know how much their situation sucks for them. Don’t be tempted to butt in and moderate or rationalise their perception of things, if their suffering seems extreme or out of context. It’s their bag,  not yours.

Give them the time and space to talk it out. Many Clinicians fear that if they let the patient continue to talk, they’ll lose control of the clinic and run out of time. Thankfully, the evidence doesn’t support this. Studies have shown that if you zip your lip, most patients will have had their fill speaking in well under ninety seconds.

Use that quiet time to really listen to what they are saying, rather than waiting for a pause to speak. Patients will often spill the real issue that’s concerning them, during their outburst, such as “I’m worried that I’ll end up like my Mother – she can barely walk and she’s only 60”.

Let them be heard, and actively listen.

Empathise with the patient.
We’ve no idea of what goes on in patients’ lives. Not being able to go to Zumba for a while may seem trivial to you, but meeting up for a jig about with friends may be the coping mechanism that’s denied when trying to deal with a husband’s (second) affair or looming redundancy.
Remain calm. You don’t have to absolutely agree with what the patient says, but it helps to legitimise their experience with non-confrontational statements such as ‘I can see why that would really upset you.’ (Even If you really hate Zumba ?)

Check in with yourself.
Let’s face it, we have viewpoints that we care passionately about, and it’s that ‘stuff’ that can lead to bias in the way that we behave towards, or communicate with, patients.

You may know what those biases are (for instance, I’m more on a wavelength with patients who love to exercise, and I sometimes struggle with patients who really have no interest in being active or who take little care of their bodies).

Try to identify your ‘triggers’ (or ask a close colleague if you’re really in the dark), and actively avoid falling into traps when you know you might be tempted to scupper the clinician-patient relationship by getting on your soap box.

You’re human, just like your patients, and sometimes our personal lives creep into our clinical lives.

If you’re beginning to see many patients in the ‘them and us’ light, consider whether you might be over-worked, regularly sleep deprived, or even becoming burnt out. Let go of unnecessary commitments and seek help from a mentor, or even your GP. Yes. I mean it.

Be proactive.
If you know Little Miss Passive-Aggressive or Mr Grumpy are likely to overrun as they spill their life’s grievances, then give them an appointment that is longer or at the end of the day. Flag them up on your practice management software system and don’t let them book into the first appointment of the day. Why risk killing your mojo by 8.30am?

Be truthful, even if it’s hard.
If treatment or surgery is likely to be tricky or painful, don’t shy away from (gently telling them the low-down on how it might be.

Documenting conversations about experiences of treatment in a clinic letter, along with Plan B’s, lessens the impact of less-than-favourable treatment outcomes, for everyone. Make sure that the patient also knows what  you expect of  them.

Involve them fully in the decision-making process to get their ‘buy in’. If they are prone to ‘passivity’, you can flag this up as being something which might preclude a certain kind of treatment, and you might want to refer them to somebody else for additional input.

Document  decisions  well and  set boundaries  for how you will communicate about things going forward.
Some patients can get very needy, and so it’s worth negotiating when it is and isn’t appropriate for them to contact you.

If they end up leaching into the next appointment slot, explain to them that you can see that they ‘clearly have more questions so let’s schedule a further appointment’. Try asking the patient what it is that they  really want?

You may be surprised that what they asking for is actually pretty reasonable. (You’ll have to make up your own mind about Zumba though).

When it comes to late patients or DNA’s, it pays to have  decided in advance what action you will or won’t take.
Terms and conditions are very helpful here, particularly if they are reiterated at the end of an appointment confirmation email. If you have a non-apologetic patient waltzing in fifteen minutes late into a thirty-minute appointment, it’s probably not fair to over-run and keep the next patient waiting.

Try cheerfully saying  ‘we have until 11.30, what is the most pressing thing you would like to talk about today?’

In the event that you have a truly rude or obnoxious individual.
Remember that you are not duty bound to have to see them in Private Practice, although you must do your best to safety-net their care.

I’ve only ever had to do this once in my own Private Practice career. In extreme circumstances, the value of your secretary’s morale and your own mental health may mean it’s ultimately necessary to ‘sack’ a patient. These situations should be extremely rare.

Tell the patient that their behaviour is unwelcome or inappropriate. I had a revoltingly flirtatious patient (with wandering hands) and for my own professional safety, I was forced to send him on his way, to the care of a large and hairy orthopaedic surgeon (with even bigger hands).

Explain to the patient that you are no longer able to continue treating them and they will need to seek assistance elsewhere. Offer to hand over their care to alternative practitioners – you may need to liaise with the patient’s G.P. if they have given you permission for this (which is best practice after all).

Attract the right patients. 
Sometimes the patients that we find tricky are the ones foisted upon us by somebody else who thought you really liked helping those kind of people. Attracting the kind of individuals whom you want to treat, means a good use of website copy, and the way that you graciously educate your referrers.

Get the message out that the kind of peeps you can help are very much ‘X’, and definitely not ‘Y’.

The flip side  is, you may yet experience the wonderment of the once disgruntled patient, turned  raving fan.
If you listen to aggrieved patients with time and a bit of compassion, you can sometimes win them over and reach a very acceptable solution together. Keep a little folder in your email system of all the lovely feedback you get from patients, to mooch through, when you’ve had a day that’s gone  a bit pants.

Whilst we can’t win them all, it helps to remember the patients that are glad of our care. Even if they do go to Zumba.

Get support from your peers.
Private Practice can be a lonely place if you don’t actively surround yourself with good people. Arrange to meet up for a socially-distanced drink, and open up if you’re finding it hard-going. Every Clinician has tough patients. Stop trying to be superhuman-ask for support.