As primary care physicians, we encounter patients from all walks of life, each with unique personalities, concerns, and expectations. While most interactions are positive, some can be challenging. Difficult patient encounters can arise due to frustration, fear, miscommunication, or unrealistic expectations. Handling these situations effectively is critical for maintaining a productive physician-patient relationship while minimizing stress for both you and your patient.
Here are five tips that I have learned during my residency that have made difficult encounters easier and more productive:
- Remain calm and professional: It is crucial to maintain composure when faced with an upset or demanding patient. It can be very easy for a patient to mirror our demeanor. It is important to take deep breaths and avoid reacting emotionally.
- Practice active listening: Many difficult encounters stem from patients feeling unheard. Actively listening with eye contact, nodding, and paraphrasing their concerns demonstrates empathy and validates their feelings. I have found this particularly helpful when patients bring up an additional (non-urgent) concern during an acute visit. It can mean a lot for a patient to hear that we are aware of their concern and will look to address it with our full attention, albeit at a future visit.
- Set clear expectations and boundaries: Patients may demand unnecessary medications, tests, or treatments. It is important to set clear expectations based on evidence-based medicine while respecting their concerns. It is important to be firm yet compassionate, such as “I understand you’d like antibiotics today, but based on my evaluation, they wouldn’t be effective for your treatment. Let’s discuss what we can do for you today, though.” This can help manage expectations while still preserving trust.
- Use empathy to build trust: Understanding the perspective of our patients can be helpful when a patient is difficult. It is important to remember that patients may act out due to pain, anxiety, or fear. It can be very productive to understand why a patient may not be compliant with their therapy or management.
- Manage non-compliant patients with shared decision-making: Some patients may resist medical advice, refuse necessary treatments, or fail to follow through on recommendations. Instead of resorting to frustration, engage them in shared decision-making. I will often say to my patients that they are the captain of their own bodies. As their PCP, I am the coach that is giving them the highest recommended plays. It is up to them which plays to act on, but we can go over together what and why these plays are recommended for their care. I have found that this opens the door to a conversation about their hesitations. I will often tell them as well that I am glad that they are feeling well today, but these are my concerns about not optimizing our care in the future if we cannot work on goals of care.
Difficult patient encounters are an inevitable part of primary care, but they don’t have to lead to burnout or frustration. Staying calm, practicing empathy, setting boundaries, and using effective communication techniques can turn challenging situations into opportunities for positive patient engagement. These skills are not an overnight achievement, but efforts made over time that will positively serve our community.
