How to deal with “problem” patients at your healthcare practice

All doctors will encounter a “problem” patient at some time in their career. Maybe a patient is highly irritable and can act out due to inconveniences, such as a long wait. Perhaps they are a chronic self-diagnoser who refuses to follow medical directions, or take prescriptions.

Problematic patients create stress for office staff. In fact, one study found that doctors make more diagnostic errors when dealing with difficult patients, compared to neutral patients. Disgruntled patients are likely to broadcast their displeasure online by writing a poor review or logging a patient complaint. These negative testimonials hurt your ability to attract new patients, particularly if you don’t proactively monitor and manage your online reputation.

Fortunately, there are methods to effectively care for “problem” patients that you can employ to increase satisfaction and boost patient retention.

In order to deal with a difficult patient, you need to use intuition, communication, and quick thinking. In chapter 288 of the book “Clinical Methods,” chapter author Steven A. Cohen-Cole advises doctors to employ a three-function model during difficult patient encounters. This includes:

According to Cohen-Cole, patients can be problematic for different reasons, and what works to soothe one patient might infuriate another. Here, we discuss a few types of “problem” patients and some patient management skills to help you handle them.

The most common type of “problem” patient is the angry patient. Patients can be angry for a variety of reasons — some of which have nothing to do with their experience at your healthcare practice. Often, angry patients are rude or disrespectful to office staff or even you, the provider.

It is natural to feel upset or become defensive when a patient directs their anger toward you. However, angry patients don’t want to be told that they’re incorrect or that their behavior is not appropriate. Rather, they want to be heard.

To deal with the angry patient, first take a moment to collect yourself. 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. For example, you could say: “I understand you’re angry. What can I do to help you feel understood?”

Flaky patients might not argue or otherwise cause a scene in the waiting room, but they’re bad for business nonetheless.

Patients who are consistently late throw off your schedule. When this happens, the best case scenario is that you spend a little less time with your next scheduled patient. The worst case scenario is you run behind the rest of the day, which could irritate other patients who arrive at their appointments on time.

Patients who no-show are even worse. One study estimates the healthcare industry loses about $150 billion to appointment no-shows each year. A similar study showed that even a single missed appointment increased patient attrition drastically: Almost one-third of patients with one or more no-shows don’t return to the same practice within 18 months.

You can try to deal with flaky patients by introducing financial penalties, but tactics like this don’t usually win doctor’s favor with any of their patients. Patients who are late to or miss an appointment for a legitimate reason will be upset when confronted with a charge, and your patient retention could take a hit.

A better way to deal with late and no-show patients is to do all you can to keep them from missing their appointment. Try sending all patients email and SMS confirmations and reminders to help keep their appointments top-of-mind.

According to Tebra's Patient Perspectives survey, 65% of patients want to receive appointment reminders via text message. Additionally, 55% say that they want text reminders when it’s time to book a new appointment. If your patients do miss an appointment, a text reminder is a great way to avoid losing those patients for good.

Another idea is to offer patients the ability to schedule and reschedule appointments online, so they don’t have to call the office during business hours, and they can be proactive about rebooking.

Dr. Google doesn’t usually provide an accurate health reading, but that doesn’t stop many patients from going online to look for answers to their medical woes. According to our research, 75 percent of adults have searched online for a doctor, a dentist, or medical care.

Patients who self-diagnose can be frustrating. They can undermine your authority by insisting on tests that aren’t necessary or treatment plans you know will not be effective. But, like angry patients, self-diagnosing patients don’t usually like to hear they’re wrong.

A better course of action is to listen attentively to what they found. After you’ve heard the patient out and completed a full examination, share your diagnosis and treatment plan, and thoroughly explain how you reached your conclusion. Without being patronizing, inform the patient that you don’t believe a particular test or procedure is necessary. You might also consider directing self-diagnosing patients to reputable online resources that can back you up.

Many people do not like going to the doctor. Whether they’re deeply worried about a condition or fearful of possible treatment, these patients can be classified as anxious.

Anxious patients might be obvious to spot — some will cry or shake, for example. Others display their anxiety in more subtle ways, such as avoiding eye contact or fidgeting. Anxious patients can be too distressed to express their health concerns or to fully absorb important information you give regarding their care. Offering your patients the option to connect with you via telehealth may even make them more comfortable in sharing their concerns.

To effectively care for anxious patients, first assure them they are in good hands. Remind them that you specialize in this area of medicine because you want to help individuals just like them. They’ll need to feel supported in order to fully comprehend their medical care. 

When appropriate, offer sympathy. If you are treating a patient with a chronic condition, for example, you could say: “I’m sorry you have to go through this. I know it’s tough, but it’s important to remain hopeful.”

Finally, let them know they can contact you at any time to ask questions or discuss their concerns.

Remember, every patient is different. Approach each appointment knowing that your bedside manner can make a big impact on their overall experience. Take the time to listen to their concerns and frustrations regardless of whether they’re related to their health and adjust your behavior accordingly.

If you remember these patient management skills, you’ll be rewarded with higher patient retention and with luck - an advocate who refers new patients to your independent practice as well.