By Jana Holt

As healthcare providers, you improve the lives of many of your patients, leading to rewarding physician-patient relationships. Occasionally, however, you must also deal with displeased, upset, angry and even violent patients who may be unhappy with the care they received. These situations can range from an angry letter written by a patient, to a verbal confrontation in the office, to even a violent physical assault on the physicians and/or members of staff.

The most common scenario that a physician or his/her staff deal with is malicious oral and/or written criticism regarding the care received, the fee(s) charged for services provided, ultimatums for a refund or refusal to pay for a bill, and sometimes threats of litigation. Some patients use more modern methods to express dissatisfaction by posting on social media any frustration or displeasure with the care received. Some choose to leave a bad review online for the physician or practice.

It is important to have internal policies in place when confronted with a difficult patient. These policies should include:

• How to assess the severity of the situation and its impact on the physician, staff or other patients present in the office (if applicable).
• The chain of command. Each employee, supervisor and manager should know their specific responsibilities in dealing with a difficult or angry patient.
• When to call authorities (security, police, etc.) as well as the contact information for the agency that would need to be notified.

Recognition of worrisome behaviors and prompt discussion between the physician and staff about how to proceed are undoubtedly the best first steps in managing the patient before his/her behavior becomes out of control.

If the physician and any designated staff members have made attempts to reason with and accommodate the patient but conclude that the patient’s behavior has become so inappropriate that the physician can no longer provide the needed care, there may be no other recourse but to terminate the physician/patient relationship.

Most patients do not become angry at their physician or his/her staff and are grateful for the care they receive. However, in those cases where a patient’s behavior is unmanageable, having a plan in place to deal with unacceptable behavior is important to minimize any risk to your patients, your staff or yourself.