What To Do When You Have A ‘Difficult Patient’


By Jonathan Ford Hughes

It’s likely that every physician reading this post has at least one difficult patient story. Try as you might, there was no getting through to this patient, who refused to do what you said. Perhaps you wonder if this communication breakdown could have been avoided.

It’s unfortunate that amid the demands of medical school and residency, there’s little time for communication training because as long as human interaction is at the core of medicine, communication will have a bearing on clinical outcomes. The good news is that communication resources abound. With that in mind, here are a few useful ideas that you can draw from the next time you and a patient don’t seem to be on the same page.

Keep your ego in check

Ego is often the ultimate communication saboteur. It can be your ego, the patient’s, or a clash of both that sabotage the care and healing process. You can’t control your patient’s ego, but you can keep your own in check.

Retired U.S. Navy SEALS Jocko Willink and Leif Babin offer these battle-tested insights in their leadership bestseller, Extreme Ownership:

“Ego clouds and disrupts everything: the planning process, the ability to take good advice, and the ability to accept constructive criticism. It can even stifle someone’s sense of self-preservation. Often, the most difficult ego to deal with is your own.”

The next time you encounter resistance from a patient, ask yourself, where is the resistance coming from? Is it from your ego, or theirs? Chances are, the frustration is at least in part coming from your own ego. Set the feelings aside, and seek to understand the patient and their situation.

Seek first to understand, then to be understood

“Physicians often know how to talk, but they often don’t know how to listen,” says Dr. Jacqueline Huntly, MD, a physician career and leadership development coach. As the old song goes, sometimes patients that you perceive as difficult are just misunderstood. To find out what’s really going on, Huntly says you have to ask questions and listen.

Is the patient not following your advice? Well, what’s their emotional state? What’s contributing to it? Maybe they have a poor support structure at home. Maybe they’re not getting what they need from hospital staff. Or maybe there are cultural or language barriers that are interfering.

Sometimes, patient beliefs about health and healthcare are impediments. Do they see becoming well as a passive process, or do they see that they need to be involved, making decisions, cultivating habits, and doing the things you suggest?

There’s only one way to answer these questions: follow habit 5 of Stephen R. Covey’s 7 Habits of Highly Effective People, which reads, “Seek first to understand, then to be understood.” Ask the questions mentioned above in this section. Really understand where your perceived difficult patient is coming from. Then, once you better understand them, you’ll know how to better guide them.

Converse, don’t lecture

Huntly says that communicating with an allegedly difficult patient is often a matter of adjusting the format. It’s less of a lecture and more of a discussion.

“A lecture creates a passive experience for the patient,” Huntly says. “Good communication is an active process.”

The natural back-and-forth rhythm of a conversation ensures that both parties are intellectually engaged with the subject. Neither party has the ability to check out, otherwise they’ll be left in the dust of the conversation. This is especially effective if the conversation takes on a question-and-answer format. After all, you are first seeking to understand, right?

Check for understanding

Expert communicators don’t assume that their audience understands what they’re talking about. They verify it. This is perhaps critically important for physicians. To illustrate just how important this is, think back to when you were a first-year med student and you were learning the skills and information that are now second nature to you. It wasn’t so easy to integrate both, was it?

Now, think about your daily interactions with patients. Much of your day consists of explaining procedures, diagnoses, and care instructions to people who know nothing about medicine. Ask yourself, how was this explained to me when I was a student? Craft your explanation along those lines.

But don’t just stop there. The exams you took as a medical student were knowledge checkpoints. No patient or patient’s family should be able to pass your class without a knowledge checkpoint either.

“A physician must ensure that they’ve managed to the best of their ability to communicate meaning and verify understanding,” Huntly says. “That often requires getting feedback from the patient.”


-Is it a “difficult patient” or simply a communication breakdown? Here’s how to communicate better as a physician:

-Keep your ego in check. If a patient doesn’t seem to be listening to you, don’t take it personally. Instead, take your ego out of it and find out what’s really wrong.

-Seek first to understand then be understood. Understand the patient’s situation by asking questions and listening carefully to what they have to say. Wait to offer an opinion until they’re done explaining themselves.

-Converse, don’t lecture. Your face-to-face communication should have a natural ebb and flow, like a conversation. This will keep the patient engaged.

-Check for understanding. Verify that the patient or patient’s family knows what to do. Don’t assume that just because they listened well that they understand you.


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