DEALING WITH DIFFICULT PATIENTS:  PART I 

GENERAL COMMUNICATION TECHNIQUES

Patients can be difficult – and for many reasons. These are trying times. People are dealing with unemployment, job uncertainties, home foreclosures, military involvements, money problems, and health concerns. These patients come to you for comfort as well as healing and many have unrealistic expectations about the course of their maladies as well as the cost of their treatments.

Patients spend a great deal of time in the presence of the staff and in some practices that can be upwards of 85% of their time in your office. It is important, then, that all people who come in contact with your patients have good communication skills and are able to treat them with care and professionalism. This is particularly true when dealing with patients who are demanding, disruptive, grieving, uncooperative, or just generally crabby.

Many medical professional liability lawsuits result from a perceived lack of caring by their medical professionals. Good communication helps improve patient care and physician defendability. Ethical and caring communication between you and your patient requires honesty, accountability, and trust. It avoids defensiveness, blame, and argument.

There are a number of techniques that can be helpful in dealing with difficult patients, but none will be effective if they do not come from an attitude of caring and service. While it might appear that some of these techniques are time-consuming, they may not be. In fact, time spent in getting to the root of the patient’s dissatisfaction can speed up interactions in the future and make for a calmer, less stressed work environment for everyone.

Studies are clear that patients feel more satisfied with their care when they perceive that the physician and staff spend more time with them. The following techniques help increase this perception, without adding much, if any, additional time to the interaction.

Techniques to improve your non-verbal communication:

• All patients should be acknowledged when they enter your practice, minimally with eye contact, a nod, and a wave;
• Have direct, lingering eye contact with the patient;
• Avoid looking at clocks or watches or charts;
• Put yourself at the same physical level as the patient;
• Use open body posture as it makes you look more receptive;
• Do not allow any distractions to your patient interaction;
• Show on your face that you are interested in what the patient is saying;
• Smile when appropriate. Let your face show your interest;
• Touch the patient in appropriate places, like the forearm, or with a handshake; and
• Make sure your clothing is clean and professional. Patients are particularly aware of your shoes.

Techniques to improve your verbal communication:

• Start with open-ended questions which allow the patient to start talking. Simply ask: "How are you doing today, Ms. Rodriguez?" or "What brings you in today, Mr. Smith?"
• Do not interrupt. If the patient is venting, let it go on for a bit, then…
• Gently redirect the patient if he goes too far afield or becomes repetitive;
• Tell the patients you understand their frustrations, fears, concerns;
• Apologize for any errors or mistakes your office has made – including if you have made them wait long in your reception area or to get in to see you; and
• Give patients your plan for the future for them.

In the next article, Part II, we will discuss specific ways to deal with difficult patients, those who present to you with a number of challenges. The techniques described above give a solid foundation for dealing with all patients. In the next article we will offer techniques for dealing with a wide range of troubling communication issues.

IND offers three risk management programs per year, two in Las Vegas and one in Reno.  In addition, tailored programs are also held for nurses, administrators, and medical office staff.  Information regarding these programs can be found here:  http://www.ind-insurance.com/risk-management.  Please contact Idora Silver, IND Director of Risk Management, at (775) 829-0606 if you have any specific risk management questions or would like to consult with her on customizing a program specific to your needs.