Dealing With Difficult Patients

As we all know, not every patient is positive, willing to work hard or grateful for our services. While most are fantastic and consistently reinforce for us why we chose a profession in healthcare, there are always a handful of clients that are difficult to work with, whether it's constant negativity, a serious lack of effort or even anger that they have to see us in the first place. Though policies and procedures should be in place for these situations at every workplace, especially if any conflicts were to escalate, I hear from other therapists that handling these situations in-session remains challenging and even burdensome, especially for those therapists with little support from management. Here are four tips for dealing with a difficult or inappropriate patient: 

1. Redirect to task, don’t acknowledge every word or sentence they say (if possible).

    I work with a lot of patients with chronic pain, and many of them have had bad experiences with physical therapy (PT) in the past. Some don’t know why they have been referred to PT by their doctor (yet) again, and some even want to blame me for somehow summoning them to the clinic. As the healthcare professional, it is important to set a kind, but firm tone early on, specifically at the Initial Evaluation (IE). I have found it best to not jump to answer every word I hear during the evaluation, but to respond to their overall questions or concerns in a relaxed, even informal way. Redirecting the difficult patient's attention back to the situation at hand, usually to the subjective or objective portion of the IE, is important to keep the patient grounded in the present situation and to avoid getting carried away ruminating on the past or even on future hypotheticals. Once I've gotten a few words in edge-wise in an informal and positive way that conveys some degree of understanding (however confused I may be as the practitioner), many patients let their guard down over the course of a few minutes; this lets us come to terms with our expectations of each other and we can then have an honest conversation about their goals and how I can help them achieve what would be meaningful to them.

2. Still not going well? Pause the session, give them the choice to either finish for the day or continue with a different train of thought/speech.

    Let's say you're trying to work through your IE or treatment session, and a patient continues to be very difficult - either refusing to participate, continuing to complain about matters outside of the session or even being rude or a distraction to you or other therapists and surrounding patients. Pausing the session and presenting to them the choice to continue is my next step. This I have had to do on a few occasions, and it is typically successful in redirecting the trajectory of our session. I specifically remember one client being so angry about her transportation difficulties and the traffic getting to her PT appointment that we did not even make it to the warm up before we had to pause the session to decide if we were going to be able to proceed. It is not fair to you as a practitioner to endure much in the way of misdirected anger or harsh language, and we as practitioners have to consider our environment and those around us. Ultimately, some clients will make the choice to cancel or reschedule, and that is likely most appropriate at that time if they cannot make the necessary adjustments. Usually, many will apologize and I will quickly change the subject to not harp on their original irritant or magnify their poor behavior.

3. Never want to do that again? Schedule with another practitioner if available (different gender, age, etc. as needed) OR (like me, I would not have that option) speak with your supervisor and place a hold on future sessions for that client. 

    Redirection not working? Provision of a choice and even a reschedule still getting nowhere? Time to regroup. You can either try to schedule the patient with a different in-house therapist - maybe there are certain demographic characteristics that would lend themselves better to the situation - or inform the patient that "unfortunately, this is not working out," their therapy will not continue at your clinic, and they are welcome to seek care elsewhere. This is not always well-received but after repeated attempts to make the situation more appropriate, you must do what it best and safest for yourself and those around you.

4. In any case, inform managers about any uncomfortable situations immediately.

You want management to be aware early on in any negative situation, and withstanding verbal (or any other) abuse is not part of any job description.  If you ARE the manager (💪) you may have more control over who you and your clinic sees - don’t be afraid to exercise professional discretion in terms of who is appropriate for treatment. The quality of your work will continue to open doors for you outside of that one inappropriate client, and current clients will appreciate, and return to, a peaceful and safe environment.

Have a challenging situation to share? Want more advice? Do you have additional tips or tricks for tough situations like these? Leave a Comment, Question or Suggestion below!