Seven Challenging Patients Who Get Under Our Skin

• The Non-Adherent Patient. Even though these patients are fully instructed to elevate their post-surgical foot, keep their cast or bandage dry, slowly break in their orthotics, wear that night splint, or finish an antibiotic prescription, they fail to comply. Yet they still insist that they have “tried everything!” The plentiful and almost predictable excuses may include: “I forgot,” “It was too uncomfortable,” “I HAD to shower!” or “I had no time.” None of these justifications are going to achieve the result the doctor and patient are looking to achieve. I guess “tried everything” has its limitations?

• The Entitled or Demanding Patient. This patient expects and is used to receiving preferential treatment, perhaps because of social, political or economic status in the community. It could also be that doctors have a tendency to capitulate to this type of individual. They may do so to appease the patient, keep the peace or seek to avoid a negative encounter, even if it means disregarding other patients. Sadly, this validates that “the entitled” once again get what they want when they want it. As a result, these patients will come to expect nothing less in the future.

• The “Pretend” DPM (with an imaginary “degree” granted by Google University). Studies show that in seeking health-related answers, people research their foot condition online to learn about symptoms, diagnosis and available treatments. This is understandable. It is the patients with Internet medical data overkill that come prepared with pages and pages of downloaded files, seeking attention and affirmation, and stealing valuable physician time. They self-diagnose, dispute the doctor’s advice and attempt to advise the doctor what treatment is best and exactly how to proceed. It is a wonder these patients even make an appointment! 

• The Schedule Abuser. You know these patients. They are the persistent late-comers, appointment breakers and cancellation bandits. While staff and doctors work hard to keep patient flow moving and backups to a minimum, schedule abusers blow it all out of the water with their blatant disregard for office policy or the outcome of their actions. Whether they choose to show up (or not) becomes a costly guessing game that none of us want to play.

• Liar, Liar, Pants On Fire. These patients insist on holding back or fail to tell the truth about certain information during their initial patient history, which may or may not impact their care. Perhaps you have heard the following objection when a patient objects to questions to ascertain his or her patient history: “This is irrelevant! What does my (smoking, weight, blood pressure, diabetes, etc.) have to do with my feet?” Another truth denier is the post-surgical patient who repeatedly insists and replies “yes” to the question: “Did you stay off your foot as instructed?” Yet the bottom of his or her worn-away cast offers the more accurate story.

• The Non-Payer. In what other universe besides medicine can you receive a service or a product, and not feel obligated to pay either now or over time? Try going to the store for groceries and asking the cashier to “bill me.” How about getting the brakes on your car fixed and telling the mechanic “I’ll send you a check?” Patients have become brainwashed (by insurance companies) that it is okay for doctors to wait for their money, which sometimes is never received.

• The “Telemedicine” Patient. It is common for patients to ask “Why do I have to come back to the office? Can’t you just explain my test results over the phone?” Another common refrain is “Just shoot me an e-mail, tell me why I am having trouble wearing these orthotics and what our next steps should be.” Most often, it is a question of not wanting to make another trip back to the office (and paying another co-pay) without really considering the doctor’s valuable time or expertise. Many providers now have the choice of responding to patient questions through secure online health management tools. This access is beneficial for doctor and patient as it may allow one to view test results, doctor’s notes and bill paying options. It stands to reason why the caregiver’s ability to explain, listen and empathize face to face can have a profound effect on functional health outcomes and genuine patient satisfaction.

How Does One Manage These Various Patient Types?

Of course, recognizing and relating to these behavioral types is one thing. How to deal with them is quite another. What you can do to address each one actually boils down to a few simple actions.

• Set financial, appointment and tele-conversation policies and stick to them. It is important that the entire staff is on the same page and everyone is consistent in their delivery.

• Set clear doctor-patient boundaries, address incorrect facts and refocus the conversation and attention in the right direction.

• Give respect to get respect.

• Treat all patients fairly and equally. 

• Learn persuasive communication skills to break through barriers, build bridges and enhance patient understanding. 

• Create a safe place for patient questions and offer comprehensive answers.

In the end, we all find a way of dealing with behaviors that are different from our own. Rather than try to “fix” those patients who we find challenging, our goal as professionals should focus on treating them (yes, even the more difficult ones) with compassion and respect while making a genuine effort to understand and appreciate their uniqueness. After all, think how boring life would be if we all had the same personality!

Ms. Homisak is the President of SOS Healthcare Management Solutions in Federal Way, Wa.