American Association of Clinical Endocrinologists

Tips for Handling Difficult Patients

by Aakif Ahmad, DO

First try to prevent difficult situations. You can try achieve this by limiting double bookings and starting clinic in a timely fashion. Have scheduling staff remind patient to arrive early or allow extra time for traffic so patients are on time. Set a tone of mutual respect. Try to show the patient you respect their time as much as they respect your time. Sit in the room with the patient. If you need to type while interviewing the patient try share the screen so the patient can see along with you.

If the patient is angry, try to see what they are frustrated about without becoming angry yourself. Try to find and address the source of their anger. A lot of times anger is being redirected or the patient feels as if their main concerns are not being appropriately heard. They may also be upset about something unrelated. Acknowledging the anger, without needing to apologize, can help the patient feel understood.

If the patient is noncompliant, try to determine the patient’s motivations and goals. Try to pick a single action they can start taking to help improve their health. Try to align their motivation with medical goals. Motivations may include improving health to have a procedure, take care of a family member, or prevent long term complications. Patient’s goals can include reducing medication burden, feeling better, weight loss, or not developing complications that friends or family members with similar conditions developed. If the patient is noncompliant due to comorbid depression then a referral to a mental health provider should be considered. If the patient is non-compliant due to misunderstanding regarding therapy, a detailed review of risks and benefits of the therapy can build trust. Also, reviewing how you will be monitoring for safety with different therapies can be helpful.

If the patient is demanding particular treatments such as growth hormone, testosterone, or holistic remedies that are not indicated, review the risks of such therapy and explain that you will not engage in actions that may harm the patient. Sometimes the patient is actually trying to find relief for chronic bothersome symptoms and has their hopes pinned on a hormonal supplement. After a discussing why you think it would not be helpful or necessary, patients are usually open to secondary evaluation with their primary provider. It is better to take some time to explain how you are coming to your conclusion than to make the patient feel their concerns are being dismissed.

If the patient is worried, but well, reviewing all their labs and all the conditions that have already been ruled can sometimes help the patient feel safe. Letting the patient know you understand that they are not feeling well but that they are medically safe can be helpful.

Sometimes going for incremental improvements with close follow up helps build trust in the plan instead of expecting large leaps in treatment every 3 months.

What we say and what someone else hears are not always the same thing. Pick your words carefully, with empathy for the patient, and you will build many rewarding patient relationships.

© Copyright 2018

AACE THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS