HealthFebruary 07, 2020

How to deal with difficult patients: Rebounding from a tough encounter

By: Brian Wu, MD, PhD

I learned how to deal with difficult patients early in my medical career. The first time I had to do so, the patient was a middle-aged man who was living on his own with no close family or friends. He had developed an intestinal obstruction and had a number of distressing symptoms, including intense pain. As soon as I walked into his room at the beginning of my shift, he exploded in an angry tirade of emotional abuse against the hospital, the nurses and, of course, the doctors. I couldn’t get a word in edgewise. Even though I knew it was unprofessional, I found myself wanting to make an angry rebuttal.

As physicians, we’ve all had interactions with patients that were unpleasant, emotionally trying or even physically dangerous. It’s how we rebound from them that makes the difference.

Rebounding from a difficult patient encounter

In the moment and just after, what’s most important is learning how to move on from the encounter so you can get on with your work. Of course, this may be easier said than done. Here are some steps to take.

Try to de-escalate

Sometimes an emotional or tense situation gets out of hand more quickly than you think it will. Trying to take the situation down a notch and de-escalate the crisis will make it easier for you and your patient to recover before the encounter is even over. As most communication is nonverbal, be careful of your body language and the tone and volume of your voice. Using a calming voice and not being afraid to step back and let the patient vent can help the situation cool itself down.

Repair the relationship

Once de-escalation has occurred and the patient is calmer, work on repairing the relationship. If apologies are needed, don’t be shy about offering them. Though it may be difficult, let the patient know that you empathize with them and that you understand that they’re going through a stressful or traumatic situation. Rebuilding this emotional connection with your patient can make it easier for both of you to move on from the difficult encounter.

Don’t take it personally

When a patient is angry, verbally abusive, confrontational or otherwise “difficult,” it can be challenging to keep your cool and step back from the situation. In some cases, you may actually question yourself, your decisions and even your abilities. Remember that for the patient, it is often truly not personal. Pain, fear, a devastating diagnosis or other factors can be the true cause of the problem, not you.

Take a break

Sometimes, just physically removing yourself from a stressful situation and taking a breather is the best thing you can do. Get off the floor, grab a cup of coffee and take a few minutes for yourself. Stepping away physically can sometimes help you step away emotionally and can help you get a more detached perspective on what has happened.

Talk it over

Another way to gain a more objective perspective is to discuss the experience with a trusted colleague or mentor. While you should avoid the temptation simply to vent—hammering home your own point of view and working yourself up again—talking the details over and getting someone else’s take can aid in productive reflection.


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Understanding the factors at play

Once you’ve taken these immediate steps after the confrontation, it’s also important to rebound in the longer term. Based on what happened, what steps can you take to prevent similar situations in the future?

Patient encounters are by definition complex. Clinical psychologist Dr. Karen G. Dyck noted three core factors that may contribute to a difficult situation: the patient, the provider and the environmental or situational context. Understanding these factors can help you look back after a difficult patient encounter and analyze the problem more clearly, a task that can be hard to achieve in the heat of the moment.

This may seem challenging, but we should already have everything we need to do it in our professional toolbox. As doctors, we’re taught to analyze, and even when the problem is related to interpersonal challenges like how to deal with difficult patients, these skills should serve us well.

The patient

Working with patients who have behavioral problems such as being unreasonably angry or demanding, drug-seeking or abusive can lead to challenging interactions. These behaviors can stem from a number of problems, including a psychiatric diagnosis, financial stress, chronic and/or multiple health problems or uncontrolled pain. Repairing the individual relationship can help set you up for a smoother encounter next time, but assessing what patient issues contributed to the difficult interaction can also help inform your approach with other patients in the future.

The provider

We bring our own problems to the table, as much as we try not to. Doctors who are overworked, not sleeping well, dealing with their own physical or mental health issues or just struggling with the pressures of the job can make a difficult situation even worse, often without realizing it. While remembering not to take a negative patient interaction personally can help you cool down and refocus on other patients, you should also take the time to reflect on what potential factors you yourself brought to the situation so you can mitigate them next time.

Perhaps surprisingly, literature could provide one way to close the gap between difficult patients and providers. According to a paper published in Academic Medicine, reading and analyzing medically themed fiction, creative nonfiction and poetry can help physicians build empathy for and sensitivity toward difficult patients. Following a challenging encounter, try engaging with other people’s stories and see if it changes your perspective on your patient or helps you see the situation from their point of view.

The situation

There are still other contextual factors that may have a big impact on our interactions with patients. Things like long waits, uncomfortable environments, poor communication from staff or similar issues can raise patient stress levels and lead to frustration, anger or even aggression. Some of these factors may be out of your control, but analyzing them can help you identify where you might be able to exert a positive influence.

By taking both the short and long view of rebounding from difficult patient interactions, you can keep your practice moving in the right direction.

Brian Wu, MD, PhD