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Advice from an experienced physician: Dealing with difficult patients

By Bud Chumbley, MD, MBA

Physicians have myriad reasons for choosing medicine as their profession, but I believe most of us followed this path so that we could care for patients. And I know I have found that patient-physician relationship extremely rewarding throughout my career. However, most of us occasionally will encounter a difficult patient. Dealing with these patients is a large topic that can’t be fully covered here. However, I want to provide a few practical pointers I’ve picked up over the years for dealing with difficult situations.

In my experience, the most common categories into which difficult patients fall are those with symptoms that are difficult to diagnose and those with personalities that are difficult to work with.

Difficult personalities: Making a good impression
One of the biggest complaints physicians hear about is wait times. If I am running late, I typically apologize to my patients and assure them that, now that I’m there, they have my full attention for however long it takes to resolve their issue. Many patients are more understanding once they realize that you’re running late because you’re showing others the same care that you will show them.

If you get the impression right off the bat that a patient isn’t comfortable with you, in my opinion it’s best to acknowledge this rather than push through an uncomfortable visit. Saying something such as, “I’m not sure I’m serving your needs here” or “I’m not sure I’m communicating well with you. How do you think we can correct that?” can help to reset any negative first impressions.

If you don’t think an interaction went as well as you thought it should, you could also call that patient at the end of the day or the next day with additional follow-up questions or to ask if there’s anything he or she would like to go over or didn’t get to talk about during their office visit.

Difficult cases: Utilizing your resources
In the information age, many patients look up their symptoms and attempt to self-diagnose before they visit a physician. Consider asking the patient outright what he or she thinks the problem is. Once patients are able to voice their opinion, it’s often easier to move forward with discussion of their symptoms and reach your own diagnosis.

Physicians are typically the type of people who don’t like not knowing the answers, but getting frustrated will only damage your relationship with the patient. Today’s patients are more active in their health care decisions than ever before, so don’t take a request for a second opinion as a personal slight against your medical knowledge. In my opinion, we should welcome another set of eyes and another thought process. If you’re the physician giving the second opinion, don’t rush to judge the first physician; he or she probably didn’t do anything wrong, and it’s easy to be the hero when you know the patient wasn’t happy with the first diagnosis. In most cases, you could call to get the first physician’s full opinion about the case.

If you work in a group practice, you can also take advantage of collaboration with other health care professionals if you’re unsure how to diagnose a patient. Some physicians may think that asking for other opinions diminishes their credibility, but in my experience most patients appreciate it when doctors are thorough and use the resources at their disposal. Most patients just want to get better, no matter which physician figures out how to accomplish that.

Dismissing a patient
If you feel that things simply are not going to work out with a patient, dismissing that patient from your practice must be done carefully. If you work for a health care system, for example, in many cases a dismissal needs to go through a committee and/or all of the physicians within the system who treat that patient.

Wisconsin Administrative Code Section MED 10.03(2)(o) requires that physicians give patients at least 30 days notice before withdrawing from a physician-patient relationship. The physician must also:

  • Allow for patient access to or transfer of the patient’s health record.
  • Provide for continuity of prescription medications if the prescription medications are necessary to avoid unacceptable risk of harm.
  • Provide for emergency care.

Where possible I also recommend helping the patient find a new physician and coordinating the transition of care. This will prevent the patient from feeling he or she is not wanted.

There’s no such thing as a cookie cutter patient or, for that matter, a cookie cutter diagnosis. If you’re unsure about how to proceed with a difficult patient, don’t be afraid to ask a colleague for suggestions.

The views and opinions expressed in this blog are solely those of the author and do not necessarily represent the views of the Wisconsin Medical Society, Wisconsin Medial Society Holdings Corporation or its subsidiaries. Nothing in this blog should be construed as legal, financial or clinical advice.

Clyde “Bud” Chumbley, MD, MBA

Doctor Chumbley, the chief medical advisor for Wisconsin Medical Society Holdings, is a seasoned physician executive with 24 years of experience in complex multispecialty medical groups and integrated health care delivery systems. As a practicing OB/GYN and management consultant, he has worked for some of the largest health systems in the country, including Aspirus Network and Baylor Health Care System. He also has held leadership positions for organizations including the American Medical Association Regional Policy Board and the Wisconsin Collaborative for Healthcare Quality.

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