Dealing with Difficult Patients

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.

3 Questions Doctors Must Ask When Dealing with Difficult Patients 

1. What does the patient want?

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 toward remediation.

2. Why is the patient upset?

Next, understand why the patient has become a “difficult patient.” Here’s what we recommend:

• 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.

Your staff 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.

3. Can you live with the suggested remedy?

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: 

1. 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.
2. 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.

Real-World Situations

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

Situation #1: 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”  or “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.

Situation #2: Difficult Patients Who Demand Unwarranted Refunds

Patients may sometimes make unwarranted demands for refunds for services they deem unsatisfactory, often without a basis in the quality of care received. Medical Justice assists doctors in navigating these situations by offering advice on how to respond to refund demands while adhering to healthcare laws and ethical guidelines. We evaluate the legitimacy of such demands and develop strategies to address them, including drafting policies on refunds and financial disputes. Our goal is to protect doctors from being unfairly pressured into financial concessions that are not justified and ensure that responses to refund demands are appropriate, lawful, and fair to both parties.

Situation #3: Difficult Patients Who Post Defamatory, Fake, or Exaggerated Reviews Online

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 with 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 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.

Situation #4: Difficult Patients Who Threaten a Licensing Board 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 enlist 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:

1. Formally terminate the doctor-patient relationship
2. Neuter 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 counsel before acting.

How to Fire a Difficult or Disruptive Patient from Your Practice—Without Getting Burned Yourself

Sometimes ending the doctor-patient relationship is the best path for both the doctor and the patient. Is firing a patient an easy, risk-free solution to a distracting patient conflict? Absolutely not. But there are ways a doctor can fire a patient while minimizing the risk of a bad outcome— such as an abandonment charge or a frivolous medical malpractice lawsuit.

Doctor-Patient Conflicts

Conflicts between doctors and patients can arise from a variety of issues, including:

• Disagreements over treatment plans
• Dissatisfaction with outcomes
• Communication breakdowns

These conflicts, if not managed properly, can escalate into complaints, negative reviews, or even legal action. 

Doctors want to treat as many patients as reasonably possible, but when the doctor-patient relationship decays, having the wisdom to part ways is invaluable. If your patient exhibits any of the behaviors listed below (either in front of you or in front of your staff), re-evaluate your relationship with the patient:

• If the patient threatens to sue you, fire that patient
• If the patient regularly harasses your staff, fire that patient
• If the patient refuses to commit to any payment plan (even a symbolic one), fire that patient
• If the patient’s expectations are unreasonable, fire that patient
• If the patient threatens to extort you (give me a refund or I’ll sue/slam you online), fire that patient

(Of course, there are exceptions to every rule…but these principles apply more often than not.)

Every “red flag” mentioned above represents a node of conflict between doctors and patients. Retaining a patient after they’ve raised just one of these red flags will create problems for your practice down the road. They’ll become a drain on resources—a sink that swallows your time, your money, and your staff. Plug the drain by terminating the doctor-patient relationship.

We cannot emphasize enough how critical it is for doctors to consider the observations and feelings of their staff when evaluating a patient’s bad behavior. Your staff likely sees a side of your patients that you do not. And we’ve seen cases where a doctor has lost valuable, well-liked members of their team because a difficult patient was not fired in a timely manner.

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. 

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.