Medical Justice has been protecting doctors from medico-legal threats for 20+ years – and we’ve seen it all. We know how to de-escalate conflicts with difficult patients. Why? Frequently, medico-legal threats are propelled by difficult patients.

And it must be said: Most patients love their doctors. And most doctors like (even love) their patients. Which is why understanding how to de-escalate the outliers is critical. This article will summarize best practices.

If you are dealing with a difficult patient (or predict you will be soon), a free consultation with our executive team – it’s fast and easy. With that said, let’s begin…

3 Questions Doctors Must Ask When Dealing with Difficult Patients 

  • What does the patient want?
  • Why is the patient upset?
  • Can you live with the suggested remedy?

When dealing with a difficult patient, first identify what the patient wants from you. This is the first step. They may want a refund. Or a “free” revision procedure. They may just want to vent. They may just want you to listen. Each patient is different. You don’t have to provide a monetary gift to make them “go away” – in fact, without proper counsel, we advise against it. But once you understand what the difficult patient wants, you can begin taking steps towards remediation.  

Next, understand why the patient has become a “difficult patient.” Consult your staff. A difficult patient is frequently a known entity among your employees. While some patients “go bad” overnight, most signal their difficult predispositions early. Train your staff to identify the tell-tale signs of a difficult patient. This can save you. Your staff interacts with the patient directly (like you do), but the backdrop is different. They are more likely to speak to the patient over the phone or while the patient is waiting to receive care. 

They can likely identify what triggered the patient’s bad behavior – an unexpected bill, a subjective expectation that was not met, long wait times, etc. Their insights will help inform remediation strategies. 

Once you’ve identified what the patient wants and why the patient is upset, you must ask yourself the following questions:  

What will make the difficult patient “happy?” What will satisfy them? And if you can identify a remedy, is it reasonable?  

Important detail: We’re not suggesting you give the difficult patient exactly what he wants – at least not without conditions. But considering what will satisfy the patient is critical. 

Frequently, the answer is money. The difficult patient often wants cash. Shocking.  

Let’s bring two truths to light. If a patient demands money from you, pause. Writing a check and hoping the difficult patient will disappear is a horrible idea. There is nothing stopping the patient from cashing your check, jumping back into his car, and returning to the practice to provoke you and harass your staff. That said, sometimes returning some or all the money a patient paid works.  

But the arrangement must be conditional – in exchange for this modest sum, the patient’s undesirable behavior must cease. Frequently, this arrangement also releases the patient from the doctor’s care. And in the event the patient violates this contract (memorialized in a release), takes the money, and continues their bad behavior, the doctors must have appropriate legal consequences at the ready.

If this describes your situation, Medical Justice can work with your practice to neutralize this problem. Schedule a free consultation with our executive team to get started.

Our article continues below.

To briefly review, when dealing with a difficult patient, keep these questions in mind… 

  • What does the difficult patient want? 
  • Why is the difficult patient upset? 
  • Is their suggested remedy reasonable? Can you live with it? 

You must also consider the legal consequences of supplying/implementing the remedy. As we said before, don’t just wash the patient in cash and pray they’ll vanish.

Now that we’ve broadly defined best practices for dealing with difficult patients, let’s consider two real-world vignettes. These are both inspired by real problems we’ve helped our member doctors address.

Dealing with difficult patients who threaten extortion… 

A member doctor is addressing a difficult patient. The doctor has worked hard to satisfy the patient’s demands but is quickly approaching their limit – the patient is unreasonable or is demanding remedies the doctor is unwilling (or unable) to supply. Then comes the threat. 

“Give me what I want – or I’ll sue.”  

This threat also has a cousin. 

“Give me what I want – or I’ll blast you online.” 

The precise language is irrelevant – in the case of threatening to blast someone online, this is extortion. And we bring this up because this behavior is typical of difficult patients. First, don’t surrender to the patient’s demands. Doing so is like feeding a stray cat – the patient will only come back for more.  

The solution? Release the patient. But do it properly. There are ways doctors can formally terminate the doctor-patient relationship without running the risk of abandonment. It is critical that doctors seek qualified counsel before dispensing a release – this is not a DIY kind of document. Medical Justice is equipped to tackle these challenges.

Schedule a free consultation with our executive team to get started. 

Dealing with difficult patients who post defamatory (or fake/exaggerated) online reviews… 

The patient in the vignette above was courteous enough to dispense a warning before acting: “Give me what I want – or I’ll blast you online.”  

Here’s the reality – most don’t give a warning. Most just do it. Or they threaten to do it again after they’ve already done it once. And if the doctor-patient relationship has soured, expect the worst. Proving defamation in court (especially online defamation via a patient review) is difficult. Doctors who try frequently waste their money and their time. Litigating difficult patients in this way is often a crapshoot.  

A better solution is to enlist the services of qualified experts – entities who understand the online world as it relates to patient reviews. Task these experts with crafting responses that defuse online conflict. There are ways you can tell your side of the story without making the problem worse. 

A critical take-home point: You must enlist someone who understands HIPAA viscerally. Responding to difficult patients on the internet without legal supervision is dangerous.  

Medical Justice tackles this problem in several ways: First, we evaluate defamatory reviews and craft HIPAA-compliant responses. These responses are customized to suit the conflict at hand and are dispensed judiciously. If there is evidence responding to a review will only incite the patient, we’ll pursue other remedies. Regardless, the practice gets to tell its side of the story. And because we understand the law, our responses are HIPAA compliant and designed to de-escalate the conflict. No doctor has ever profited from a prolonged online debate with a patient.

In addition, we supply practices with a survey tool that posts 99% of reviews collected to top sites. Assuming captured feedback is mostly positive, this dilutes the effect of a rogue negative review. 

Schedule a free consultation with our executive team to learn how these techniques work together to protect a practice’s online reputation.  

Dealing with difficult patients who threaten a Board/licensing complaint… 

A threat to file a complaint with a licensing Board frequently gives doctors pause. Our license to practice medicine is our lifeline. Once that license is tarnished, recovery is slow.   

Sometimes patients will demand money in exchange for not filing a Board complaint. The solution is frequently to release the patient, but when a Board complaint is in the proverbial chamber, it is critical a doctor enlists the help of experts who know how to de-escalate a conflict with a difficult patient. A standard release form won’t cut it. The language in the release must a) formally terminate the doctor-patient relationship and b) neuter the patient’s threats. Further, one cannot tie a release with the patient promising not to file a Board complaint. Such a term is against public policy.  

The patient’s threat is likely empty and the complaint, even if propelled, would likely be perceived as frivolous by the Board, particularly if the patient threatened such action unless a check was forthcoming. But doctors must commune with legal counsel before acting.

Doctors are trained to care for patients but dealing with difficult patients is an art in and of itself. It’s not something addressed in our training – at least not in detail. In our opinion, it should be, because dealing with difficult patients is a practical reality of practicing medicine. It happens to everyone. 

In closing, if you are currently dealing with a difficult patient, we are sorry you are in a tight spot. We’ll close with a straightforward remedy: Seek help. You don’t have to go it alone. There are qualified experts out there who understand the playing field and know how to deal with difficult patients. 

Medical Justice has been protecting doctors from difficult patients (and a bevy of other medico-legal threats) for 20+ years. If you are reading this article because you are dealing with a difficult patient, request a free consultation with our executive team.  

A brief conversation with us can provide peace of mind – and likely solutions. Click here to schedule your free consultation – it’s fast and easy.

And lastly, let us know your thoughts in the comments.

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Our Executive Team walks with our member doctors until their medico-legal obstacles are resolved.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.