How to do everything better: Deal with demanding patients

Patients banging their fists at reception, yelling at staff on the phone, demanding to be seen, insisting on certain tests, prescriptions or procedures: It does not make for an easy day at a clinic. How to handle this kind of difficult behaviour? Approaching the situation with compassion and empathy is what Dr. Marcus Greatheart, a family physician in Vancouver, recommends. For someone wanting to be seen now, he said that he and his staff try to understand what is behind the patient’s urgency. “Sometimes folks just have to be heard and reassured,” he said. “That’s often what our nurses will do.” Sometimes what we might perceive as demanding or challenging might be a cultural misunderstanding,” Dr. Greatheart said. He said that a quick conversation with the patient usually changes the tone. Dr. Greatheart, a former social worker, teaches physicians about patient-doctor communication. Dr. Greatheart said that physicians may need to see some patients with a trauma-informed lens. “Sometimes patients are doing the best they can to ask to get their needs met,” he said. “It can be socially awkward or inappropriate, but oftentimes it is the best that folks have, so we can address that.” He said that doctors must remember that colonization has taken a large toll on Indigenous patients. “The onus is on us to understand that history and how it might create tension in the clinical space with our patients and it is up to us to address, to acknowledge and to support those patients.” For people who are asking for a certain test or procedure, Dr. Greatheart just reiterates what he can offer based on the medical evidence and his training. His script goes like this: “We can offer this, or that, however the test or treatment you are requesting is not something I can offer today,” he said. “And then I shut up.” Dr. Nadya Sankat, a family physician in Brampton, Ont., takes time to fully explain why a treatment or test is needed, or why it’s not recommended. “Generally, I find with a family practice patient, you get to know the patient and have an understanding of them and the reason for the request,” she said. Dr. Sankat said sometimes she and the patient come to a compromise that they are both comfortable with and is medically appropriate. “However, there are always rare occasions that patients will not be satisfied with the end result, even with appropriate and effective communication and discussion.” Dr. Jabir Jassam, a family physician in Ottawa, also takes time to clearly explain to patients why a test or procedure might not be needed or required. He firmly declines requests when patients insist they need an inappropriate medical service. “The internet made people more demanding and anxious, and doctors more exhausted as they spend more time invalidating Dr. Google’s plan of care,” he said. Dr. Greatheart said it is important to remember that the patient isn’t difficult, the behaviour is difficult. Labelling a patient as demanding or difficult can create barriers in their future interactions with healthcare professionals. If a patient is consistently displaying problematic behaviour, Dr. Greatheart will invite them in for a meeting. They discuss, “how we work together and what they can expect from us and we expect from them,” he said. The clinic manager might join them in the meeting. “There’s always going to be disagreements between doctors and patients,” he said. “The question is how we situate ourselves in conflict. If we situate ourselves across from the patient, and we are in conflict with them, then that’s harder to resolve than if we align ourselves with them. If we are truly walking alongside our patients, to help them along their health journey, then we can address the problem together.” Basically, compassion and empathy—combined with firm refusal of inappropriate care—does work as a strategy to deal with quarrelsome patients. “It’s easier to do than most people think and the positive impact it has on the doctor-patient relationship is extraordinary,” Dr. Greatheart said.

How to do everything better: Deal with demanding patients

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