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Handling the "Demanding" Patient

Dealing with a demanding patient can be extremely frustrating! But before we delve further into how to handle these pesky buggers, let's take a moment to reflect on what constitutes a "demanding" patient.

Demanding patients exhibit a variety of behaviors and attitudes. Patients may be rude, downright nasty, non-compliant, litigious, passive-aggressive, or inconsiderate of your time. In essence, a "demanding" patient is one that requires a tremendous amount of investment on the doctor's part.

It is important to remember that patients are sick, and being sick alone can bring out the ass in all of us! Not to mention many patients are on medications (ie: steroids) or illicit drugs that may mask their true personality (at least that's the excuse I use for myself). Therefore, it is extremely important to not take the threats of demanding patients personally. In fact, placating a demanding patient can be difficult, if not impossible!

But fret not! There are many ways to deal with a demanding patient! I recommend learning as many different ways as possible because each different method is a "weapon" in your arsenal. One method may work on patient A, but not on patient B. Remember that no two patients are the same! Enough intro, let's get into some real world approaches and solutions...

The first type of demanding patient is the "confused" patient. This patient is "demanding" because they have failed to understand what is happening to them. They are lost in the massive sea that is healthcare and no one has bothered to explain why they are adrift! Ask the patient to tell you, in their own words, why they are in the hospital. If they cannot, a few minutes (literally minutes!) explaining what is happening to them can turn one nasty mother into a bucket of smiles! (And perhaps they'll even stop throwing their urinal at passerby's...)

Sometimes, no matter how much time you spend, or how much you educate a patient there are some people who will continue to be a pain in the tookus! I call this patient the "asshole". These patients can be particularly tricky to deal with, and many of them have underlying personality disorders (remember you psych rotation!). However, many will respond to the "tough love" approach. These patients typically need firm, stern, and direct confrontation otherwise they will continue to walk all over doctors, nurses, and other members of the healthcare team. This doesn't mean get in a yelling match with them, but it is important to let them know who the "boss" is. You didn't go to medical school and spend countless hours studying to be told by the patient what tests should be done or what treatment should be administered (FYI - this isn't advice they will give you in medical school!).

When all else fails and the patient continues to be overly demanding and unsatisfied with their care a simple, "you are free to get a second opinion somewhere else" will often free both patient and doctor from turning a nasty situation into a total crap storm. If they take you up on the offer you're free of their painful tactics, if not, they may re-think their demanding ways and become a more amenable patient.

And perhaps my best piece of advice... Ask a nurse! Nurses are the front line in the fight against the nasties! They deal with abusive patients on a near daily basis. When you learn some nursing skills as a medical student or doc it makes you look like a rock star, and will endear you to the health care team you work with on a daily basis.

Overall, the doctor patient relationship is exactly what it sounds like, a relationship! The patient does not have a right to abuse their doctor and vice versa. In my personal experience I have found that some patients respond extremely well to firm and direct confrontation, others to education, and others need to be coddled a bit.

It is important to recognize that there are a thousand different ways to approach a demanding patient. In fact, there are full books written about it! The best piece of advice I can give is to learn many different methods and practice them! Interacting with patients is an art form... and with a little bit of practice (and perhaps luck) hopefully you wont get any poo thrown at you!


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References and Resources

(1) Haas LJ, Leiser JP, Magill MK, et al. Management of the difficult patient. Am Fam Physician. 2005 15;72(10):2063-2068.

(1) Curbside Consultation: Setting Limits on Demanding Patients. Am Fam Physician. 2000 Feb 1;61(3):881-882.


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