Three Steps for Dealing with Difficult Patients

By: Lisa Morris on May 28, 2019

Dealing with difficult patients is hard enough on its own, but thanks to the growing influence of online reviews, patients who have negative experiences at your practice can pose a significant threat to your ability to attract new patients.

Fortunately, there are ways to make dealing with difficult patients a bit easier.

Coming up with standard policies, over-communicating them, and equally enforcing them can help mitigate unpleasant patient encounters by diffusing tense situations and preventing difficult patients from damaging your reputation online with negative reviews.

One-third of patients have had difficult relationships with a doctor

In a recent survey of over 200 U.S. patients, we found that one in three had experienced a relationship with a medical provider that was frustrating or contentious at some point in their lives.


When we asked our survey respondents to rank the reasons they switched medical providers, many selected options related to difficulties working with, communicating with, or interacting with their doctors.


Other answers included “rudeness,” the fact that the medical provider was “not personable,” and that the provider “didn’t listen to me even after I specifically told them what was wrong.”

And all this isn’t to say doctors haven’t had their share of stressful patients, either. A 2017 study found that an astounding nine out of 10 medical practices have had to dismiss patients at some point, most often due to poor patient behavior.


But firing patients can be a complicated process, and because of certain legal obligations should only be looked at as a last resort.

Before you reach that point, make sure you’ve followed these three steps to make dealing with difficult patients easier: s**et the rules, share the rules, and enforce** the rules.

Set, share, and enforce your rules to manage difficult patients

No, rules aren’t made to be broken, they’re made to make your life (and everyone else’s life) so, so much easier.

1. Set the rules

Establishing a set of office policies can help manage difficult patients by creating fair, unbiased procedures for your staff to follow in the event a patient becomes disruptive or behaves inappropriately.

You can set rules regarding any number of patient behaviors, from aggressive acts or speak directed toward you or your staff all the way to failure to make payments. When coming up with your rules, consider the following:

Are there degrees of severity to the type of patient behavior a rule aims to prevent? Or will the simple act of breaking a rule result in your practice taking action? What patient behaviors do you find most disruptive in your practice?

For example: Would you consider a patients failure to pay bills enough to fire them? Or are there more pressing issues that you’d be more concerned with addressing first, such as prescription abuse?

Once you’ve worked out what your rules will be, you’ll need to come up with a set procedure for your team to follow when a patient violates one or more of these policies. Determine what patient behavior triggers the procedure, and train your staff on exactly how to handle these situations.

2. Share the rules

Now that you’ve decided what rules you’ll establish to mitigate disruptive patient behavior, you need to make every attempt to communicate those rules (and the actions that will be taken if they’re broken) to all of your patients.

The goal here is to make it impossible for any patient to say they weren’t aware of a rule.

Email them, post them in your office, include them in your intake forms with a required signature to make sure patients read them, do whatever it takes to make these new rules as ubiquitous as possible.

Following this step will make the next one much easier.

3. Enforce the rules

If you’ve done everything right up to this point, this step should be a natural conclusion. You’ve carefully thought through what the rules should be, how your staff will determine what constitutes a rule violation, and what steps will be taken.

Now the most important thing is to make sure the rules are enforced equally. It’s important to remember that while every situation involving broken rules will likely be a little different, you should not allow exceptions.

Bending the rules for one patient and not another is a slippery slope, so maintain objectivity by enacting procedures the same way for every violation.

When all else fails, dismissing patients is an option

Yes, dismissing patients is a last resort, but never forget that you have the option in situations where behavior is just not acceptable.

The rules for firing patients can differ slightly depending on state laws, but generally, there are only two circumstances in which doctors may not legally dismiss a patient:

  1. A patient may not be dismissed for any reason related to an attribute that is nationally recognized as a protected classification, such as race, color, religion, national origin, sexual orientation, or gender identity.

  2. A patient may not be dismissed in the process of an ongoing medical treatment, also called continuity of care. For example, a provider may not dismiss a cancer patient during the course of chemo or radiation treatments, and must instead wait until the treatment is completed.

Assuming these two circumstances do not apply, we recommend following the checklist below to make the process of dismissing a patient as smooth as possible.


Of course, you never want it to come down to this, but if you find yourself needing to dismiss a patient, the above steps should ensure your practice isn’t liable.

Once you’ve dismissed a patient and followed this checklist, it’s important that you not withhold any patient data from the patient or their future providers. You want to make this process as smooth and professional as possible so the patient will have no reason to return to your practice, and both of you can be free to move on.