Four Ways to Salvage the Physician-Patient Relationship

May 29, 2012

Before you decide to terminate a difficult patient - give him the benefit of the doubt and try these techniques to mend the breac

Description: Here are four common "problem patient" scenarios you may see at your medical practice and how to deal with each one.

Though patient dismissal is a "no-brainer" in certain situations, practices must ensure that they are not discharging patients prematurely, says Meryl Luallin, a healthcare marketing consultant with SullivanLuallin Healthcare Consulting in San Diego.

As soon as a patient begins presenting "problem" behavior, first consider whether his behavior is due to a weakness within your practice. "Physicians and staff members may be frustrated by the patient, but they aren't looking at the situation from the patient's eyes," she says. Ask yourself if there are new ways to approach this patient that could lead to improvements in his behavior.

Here are four common “problem patient” scenarios and tips on how to deal with each:

When a patient is rude

Consider whether you are inadvertently triggering the patient's behavior, says Luallin. Perhaps your front-desk staff appears uncaring or insensitive and the patient is reacting defensively.

Rudeness can also be triggered by a patient’s frustration with the healthcare system in general. Make sure your staff is well trained in handling complaints and handling difficult people, she says.

When a patient is unreliable

If a patient continually misses appointments, consider whether you are inadvertently setting him up to be a "no-show," says Luallin. An elderly patient, for example, may have unreliable transportation. "Either the doctor or nurse has to double-check to make certain that the patient can get there," she says.

Also, many patients tend to ignore certain kinds of appointments, such as follow-ups after something simple, like being treated for an ear infection. Instruct staff members to look out for these visits, suggests Luallin. An extra phone call to confirm whether the patient plans to attend could help you plan accordingly.

Finally, some patients are simply unreliable. When a patient develops a pattern of failing to show, consider double-booking her appointment time. “If the patient does show up you’ve got to work a little faster, and to some extent, you do inconvenience the patients who are regular patients who do come in, but nonetheless, you’re not sitting there doing nothing if the patient doesn’t show up,” she says.

Finally, consider implementing a fee for failing to cancel appointments with adequate notice. Even if you don’t actually plan to charge patients for no-shows, it does provide patients with a little bit more incentive to either show up for appointments, or cancel them further in advance, says Luallin.

When a patient doesn't comply

Ensure you are communicating clearly with the patient, that he understands your instructions, and that he has the mental capacity to do what's expected of him, she says. Also, ask the patient why he hasn't followed your treatment plan. His answer may reveal an easy way to increase his compliancy.

Still, if the patient fails to comply despite your attempts to reorient him, and you fear that his noncompliance could negatively affect his health, then that’s the “last straw” and patient dismissal is appropriate, says Luallin.

When a patient doesn't pay

Offer a struggling patient the option of paying in smaller installments, she says.

Still, if a patient can pay but won’t pay, consider discharging him. But be careful here, says Luallin. "If you discharge somebody and they are dissatisfied and their indication of that is nonpayment, now you're setting yourself up for potential malpractice."

* To read more on dismissing difficult patients, see  "Patient Dismissal: The When, Why, and How."

Aubrey Westgate is an associate editor at Physicians Practice. She can be reached at

This article originally appeared in the June 2012 issue of Physicians Practice.