Managing difficult patients (without losing your calm)

“Difficult” is a catch‑all. Sometimes it’s anger; sometimes fear dressed as anger. Sometimes it’s a billing surprise, or a patient who insists on sleeping in monthlies “just on weekends.” The behavior is visible; the story underneath isn’t. I try to start there, even when my pulse says otherwise.

I mentally sort issues into three buckets: clinical, logistical, emotional. If it’s clinical (pain, vision drop), we lead with care and speed. If it’s logistical (insurance, wait time), we lead with clarity and options. Emotional? We lead with space. A simple, “I can see you’re frustrated—give me one minute to review this properly,” buys calm. Not always. Often enough.

Phrases that help me de‑escalate:

- “Here’s what I can do today, and what I recommend next.”

- “Let me pause and check the chart so I don’t miss something.”

- “You’re right—our estimate changed, and that’s on us to explain clearly.”

I try not to argue with feelings. Facts, yes. Feelings, no. And I don’t over‑apologize for policies that keep patients safe. “I can’t release contact lenses without a finalized fit; what I can do is prioritize a quick re-check.” Boundary plus bridge. It keeps dignity on both sides.

Prevention beats heroics. We use pre-visit messages with two lines that matter: “Bring your vision plan and medical insurance cards,” and “Contact lens trials may require a follow‑up.” A little expectation‑setting removes landmines. Also, consistent pricing scripts. “This is our exam fee; materials are separate,” said the same way by everyone, keeps us out of the gray zone where resentment festers.

When a conversation turns heated, I sit back a few inches, lower my voice, and slow the pace. It feels theatrical, but it works. If staff are being targeted, I step in early: “I’ll take it from here.” And if it crosses a line—shouting, threats—we pause. “We’re going to reschedule this visit. I want to help, but not like this.” Rare, thankfully. Still, a policy written in plain language gives everyone courage.

Documentation is boring and essential. Objective notes (“raised voice; disputed copay; offered itemized estimate; accepted”) protect future you. So does a short debrief with the team: what triggered it, what we’ll tweak, where we held the line. Sometimes we decide to discharge a patient—formally, with a letter and resources for continuity. I don’t rush to that. But I don’t avoid it when patterns repeat.

Here’s the paradox: every now and then, giving an inch (a quick no‑charge recheck) saves a mile of conflict. Other times, that inch encourages more. There isn’t a single rule. There’s judgment, informed by policies you actually follow. On good days, I remember that most “difficult” encounters are people wanting to be heard. On the rest, I take a breath, step out for water, and try again with the next patient.

Other ideas/hints/suggestions ? Good. Let's have a chat, we don't have to fight alone.

— Rad