7 Tips for Dealing with Difficult Patients

Everyone has an off day every now and again, but some patients seem almost impossible to please—or to motivate. And unhappy, unmotivated patients aren’t going to get the most out of therapy—or do your practice any favors in the word-of-mouth referral department. So, what’s a conscientious provider to do? Of course, you want your patients to be engaged in their care—and thus, more willing to cooperate. But, that’s not always the easiest feat to accomplish. With that in mind, here are seven tips to help you—and your staff members—deal with difficult patients:

1. Focus on engagement from the beginning.

When it comes to developing positive relationships with your patients, it’s absolutely crucial to set expectations at the beginning—and that goes for everything from payment policies and procedures to the role of patient participation and engagement in the therapy process. By establishing ground rules and communicating exactly how the techniques you use—as well as the home exercises you prescribe—connect with the patient’s goals, you’ll be able to not only get buy-in from the patient early on but also demonstrate that you’re invested in his or her progress.

To do that, though, you must craft a course of care that is tailored to the patient as not only an individual, but also a whole person, rather than a condition or injury. Be sure to:

• continue explaining the “why” behind your actions as treatment progresses,
• celebrate milestones to build momentum and foster intrinsic motivation, and
• keep patients engaged between sessions by providing an interactive electronic HEP along with relevant content and consistent check-ins. (Hint: Patient relationship management (PRM) software can be a big help in this area.)

2. Make it a collaboration.

Today, most patients aren’t super enthused with healthcare providers who lay down the rules without giving them an opportunity to weigh in on decisions regarding their health. In fact, on the topic of communicating with angry patients, Dr. John Cullen, president-elect of the American Academy of Family Physicians (AAFP), is quoted in this Physicians Practice article as saying, “Shared decision making involving the patient is important. It is amazing how presenting a patient with options changes the feeling in the room.”

Speaking of collaboration, this is also an important strategy for engaging with members of your staff. Dr. Cullen makes a point of holding team meetings with the specific intention of helping his staff better handle difficult patients. In one meeting, the leadership team analyzed the 20 patients the staff found most difficult and “incorporated...expectations into the patient’s treatment contract” to help. This type of collaboration can help staff members feel heard and ensure that everyone interacting with a particularly challenging patient is communicating the same message.

3. Collect feedback—and act on it.

Unlike other healthcare providers who may see a particular patient occasionally—or even annually—to treat an illness, complete a check-up, or perform surgery, rehab therapists usually see patients for multiple visits over an entire course of care. Plus, rehab therapy is only an effective treatment option if patients keep coming back—something many difficult patients may choose not to do. To keep a pulse on where your patients are in terms of satisfaction—and loyalty—we recommend tracking your Net Promoter Score® (NPS®) on a consistent basis. That way, you’ll be able to identify patients who are anything less than thrilled with their experience at your clinic and remedy the situation before they bail on you—and maybe even rehab therapy in general. You’ll also be able to spot downward trends and act on them sooner than you would otherwise. And when you do, your NPS score should improve, your patients should be happier and less difficult, and your patient churn rate—something that’s directly linked to lost revenue—should decrease.

4. Make the homework more palatable.

You can accomplish a lot during a patient’s therapy sessions, but in most cases, you’ll also need to prescribe a home exercise program for the patient to complete between sessions in order to reach his or her full functional potential. Unfortunately, handing a patient a sheet of paper with some exercises scribbled on it may lead to questions, frustration, and pushback—as opposed to compliance. Instead, consider implementing an electronic HEP complete with video exercises that will make it easier for the patient to remain engaged in his or her program—and complete it safely. For reference, WebPT’s HEP consistently achieves patient engagement rates of more than 50%, which is 10 times higher than the rate denoted in the current Medicare Meaningful Use guidelines.

5. Remain empathetic.

In the above-cited Physicians Practice article, Dr. Michael Munger suggests that patients “who are angry are generally angry for a reason. It could be they feel they sat too long in the waiting room or maybe they are just having a bad day.” Or, perhaps they have had a bad experience with therapy in the past, heard negative things from friends and family members, or were referred by a physician who doesn’t really buy into the value proposition of therapy. Regardless of what is influencing their perception of you and your services—as well as their attitude—it’s always a good idea to take a beat and better understand the situation before you react. “By actively listening, empathizing, and communicating, it shows the patient you understand the issue, you care about the patient, and you are willing to work on a resolution with them,” Dr. Munger said.

6. Avoid confrontation.

In the same Physicians Practice article, Richard Cahill—associate general counsel with The Doctors Company—suggests using “non-confrontational phrases” during discussions with patients. While this goes for all conversations, it’s especially important when dealing with already-peeved patients. Cahill gives two examples:

• “I understand this has been a stressful visit for you today, and I would like to talk with you about your experience and identify how we can improve your subsequent appointments.” Or,
• “I appreciate that your visit is running late. We apologize for the delay and want you to be comfortable knowing that we take as much time as is necessary for each patient and that unforeseen circumstances beyond our control sometimes arise.”

While you’ll obviously want to tailor your approach to the patient’s specific situation, you get the idea. Keep calm and professional—and always carry on.

7. Know when enough is enough.

Now, there’s a difference between a difficult patient and a patient who is rude, belligerent, or combative. If you’re not making headway with a patient—or if he or she is being abusive to you or your staff—then you may want to consider termination. According to Cahill, “The patient should be advised in writing that they are being terminated due to a breakdown in the [provider]-patient relationship. A detailed explanation is not recommended.” Additionally, Cahill recommends including a statement letting the patient know that “a copy of the chart will be sent to the patient’s new provider once that individual’s name and address have been provided to the practice.” He suggests mailing the letter “both by first class and registered mail, with return receipt requested,” and immediately filing a copy of the correspondence in the patient’s chart.

There you have it: seven tips for dealing with difficult patients. How do you handle difficult patients in your clinic? Has it ever come to termination? If so, how do you determine when enough is enough? Share your thoughts in the comment section below.