Handling Difficult Patients #Guest Post #PracticeIndex

I would like to thank Practice Index for letting me share their post on ‘Handling Difficult Patients’. Practice Index is a support site for GP practice managers and surgery staff. Their popular online discussion forum allows you to ask questions and gain advice and guidance on any surgery issues from the community of NHS professionals. They also have a resources library within the forum which contains hundreds of policies and protocols that you can use in your own practice. You can join the Practice Managers’ forum for free by clicking here: http://practiceindex.co.uk/gp/forum/register

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April 28, 2015 by Practice Index in Patients

Handling Difficult Patients

Dealing with difficult patients at the reception desk and in the waiting room is, like it or not, part and parcel of your job as a Practice Manager. It’s your responsibility to demonstrate confident and compassionate handling of difficult patients, displaying techniques your team – especially newer recruits – can learn and gain self-assurance from.

Keep Calm

Aggressive patients are particularly likely to try and bully you into an argument, but your role here is to stay calm and unemotional. An emotional response from you – irritation, laughter or anger – will only fuel their attack and potentially cause a situation to escalate. In nursing as much as in the general practice, sensible steps to take would include the following:

–  Speak softly and abstain from being judgemental
–  Put a little more physical distance between yourself and the patient and avoid intense eye contact which could be seen as  provocative
–  Be in control of the situation without seeming either demanding or overly authoritative
–  Show your intention to rectify the situation rather than reprimanding the patient for their behaviour

Defy Logic

An angry patient won’t respond to logical arguments, so try to resist the temptation to reason with someone who is clearly in a terrible temper. It’s also important in situations like these to not resort to all-out grovelling if the practice is not at fault. Accepting responsibility is irreversible and could do the practice damage, as well as your own reputation. What you can do, however, is apologise for the particular inconvenience your patient is aggrieved by at this moment – and offer what immediate action you can (if any) to rectify the situation. Make a note of all complaints received, formal or informal – this includes patients storming out of hanging up on phone calls.

Rise Above It

Patients can be rude and downright insulting on a bad day, but try to refrain from letting them know what you think of them or how they’ve made you feel. Stay professionally detached and see this objectivity as your ‘protection zone’ from hurt. Ignore their rudeness and you may find that, with no visible impact, their insults start to die down. Equally, treating an angry adult like the adult they are – despite the toddlerish tantrum they’re throwing – should encourage them to gently return to adult form if you’re consistent enough with it. Patronising, belittling treatment will only inflame that childish rage.

We’ve all come up against it in our time and this just scratches the surface in coping tools for difficult patients. Why not share your best advice for diffusing tempers and managing quarrelsome individuals in the waiting room?

How To Avoid Workplace Anger/Violence (part 2)

Are Patients Waiting Too Long?

Research has shown that long waiting times can lead to angry/violent behaviour. So keep your patients informed, give a reason for the delay and apologise when necessary – please do not ignore the waiting patients (see blog: When The Doctor/Nurse is running late. http://t.co/Tlnpi4OD )

Does Your Patients Feel They Have A Method Of Complaint?

Provide a well-advertised complaints procedure in your Practice Leaflet. Quite often a Receptionist can deal with a complaint before it goes to Management level.

Always offer the patient a complaints form. Ensure that all your Reception team knows where the complaints forms are kept. No complaint should go to the Practice Manager without being offered a complaints form first.

Most people when offered a complaints form will decline, and even when they do except a complaints form will probably not return the completed form. But it is important that they have that choice to make.

Are You Or Your Staff Helpful and Courteous?

An abrupt or indifferent receptionist and lack of information can often lead to frayed tempers.

Do You Think Your Receptionist Makes Things Worse?

First rule; do not get yourself into an argument. An argument may cause anger to escalate into aggression and perhaps violence. Have you as a team discussed ways to prevent or defuse such situations? Ensure that all staff have clear guidelines – this will help them deal with such a situation.

Is the Waiting Room a Calm and Comfortable Place?

Consider ways of reducing boredom, up to date magazines. Toys for the in the play area. Posters and Notices on the wall. Plenty of seating. Make it comfortable.

A local A&E Department recently spent a large amount of money re designing and updating their A&E Department and found that this reduced the vandalism by a considerable amount. Both patients and staff found it a more relaxing environment to be in.

Can Your Staff Recognise The Warning Signs?

Staff need to be aware of this at all times. If dealing with a patient who is known to be hostile, make sure you are in a position to summon help or make an escape if necessary. Bring it to the attention of others if necessary.

Does your Practice have panic buttons? Ensure that all Locums and new staff are aware of where they are situated.

Are You Aware Of Stranger Danger?

Be extra cautious if an unknown temporary resident is fitted in at the end of surgery. Warn the doctor/nurse that the last patient is a temporary patient. It has been known that a few patients are looking for drugs will book a late appointment and not complete the temporary residents form out correctly which means that the Practice has no relevant information on the patient. This is not to say that every temporary resident is like this – but there are the odd few out there.

Is Information Shared?

Everyone working in the practice needs to know which patients might pose a risk. This will apply to doctors working at another surgery for the out of hours. Especially inform all other surgeries if you have a temporary resident causing any problems. If you have a violent patient you should inform your local PCT/Health Authority.

Can The Waiting Room Be Seen and Controlled By the Receptionist?

Try to ensure that there are no nooks and crannies where people are sitting out of sight. If someone is getting agitated or poorly the Receptionist should be able to notice the signs and deal with it appropriately.

Are You Providing Weapons?

Do you equip your surgery and waiting room with items that can easily be used as weapons or missiles?

  • Paper opener
  • China Cups
  • Heavy objects such as stapler, paperweights
  • Metal toys in the children’s area
  • Sharp objects

Always ensure that potential items are out of reach.

What Should You Do If the Patient Becomes Aggressive?

  • Avoid direct confrontation and try to defuse the situation. Listen and show you are listening to their point of view – do not argue.

Can You Defend Yourself?

  • Avoid physical contact.
  • Call on others for support
  • Quite often if there is more than one person in front of the aggressive person they will calm down a lot quicker. If you hear a patient getting aggressive at the front desk, just go over to the receptionist dealing with the patient and just stand and observe, do not say anything, often this is enough to calm the person down.
  • If the Receptionist cannot deal with the situation then you might need to step in and take over.

People who are most effective in dealing with aggression understand something about the psychology of people. They understand why make people tick and recognise that human beings have basic animal instincts, which often come to the fore when they feel threatened or feel frightened or angry.

The options that our animal instincts provide are either FLIGHT or FIGHT.

Many things may affect which option we choose but some things which will increase the likelihood of choosing FIGHT are:

  • Feeling our personal space is being invaded
  • Feel physically threatened
  • Feel that our exit path is blocked.

One of the most effective ways of diffusing this natural response is to deliberately signal that you are not going to respond in an aggressive way. This may not be easy when you are probably feeling threatened yourself, but the following actions will help to signal non-aggression to others.

Give the other person space – If you increase the distance between you and the aggressor it will lessen the feeling that their personal space is being invaded and reduce the feeling of physical threat and open up their exit path. It also gives you a greater range of options should the situation suddenly change.

Relax your own posture – you can reduce your own aggressive signs by dropping your shoulders, adopting an open stance and allowing your arms to drop. Such action will probably feel unnatural given the situation but it will quickly reduce the aggressor’s feeling of being intimidated.

Avoid sudden movements – remember that heightened emotion will make an individual jumpy and ready to defend, and that quick or sudden movement might trigger an instinctive reaction.

Reduce eye contact – Sustained eye contact is a very aggressive signal in these types of encounters. You should avoid gazing intently into the aggressor’s eyes.

The above four behaviours will reduce the potential for aggressive situations to turn into violent confrontation. However, they do not, on their own, resolve the encounters successfully. Successfully resolution can be achieved by:

  • CALMING the individual and then building
  • RAPPORT with him/her to finally achieve
  • CONTROL over the situation

This sequence is very specific. Successful control of a situation cannot be achieved by trying to achieve rapport with a person who is still very wound up by the incident itself. You must calm the person down before he or she will be receptive to your attempts to build a rapport.


A common mistake, which is made at this stage, is trying to deal with the reason why the person is being aggressive. In fact you should try to deal with the emotions that the person is bringing into the situation. Trying to deal with the reasons why before you calm the emotions will only service to increase the tensions and set off an escalation of the incident.

It is vital that you as the person seeking to control the situation are fully in control of your own emotions and reactions. This is not easy because you are not immune to the situation and you may be feeling fear, excitement or anger. But your ability to control your own emotions, particularly your anger will have a vital impact.

Many incidents involving aggressive people take place in public places where the aggressor has an “audience” and it will help the situation a lot if you make the encounter a one to one situation where the aggressor will not be able to “play to the audience”. Most of all, do not put the aggressor in a situation where he or she will be seen as losing face to the audience.

In the early part of this stage, what you say in your efforts to calm the individual is probably less important than how you actually say it. How well you communicate non-verbally will be very important in sending calming messages to your aggressor.

There are several non-verbal behaviours which can help to signal non-aggression and encourage the aggressor to calm down

  • Move slowly – sudden, quick or unpredictable movements can sign aggression particularly to someone who is already tense and feeling threatened.
  • Allow space – respect the aggressor’s “personal space”. Moving into a person’s personal space is very intimidating and almost threatening.
  • Reduce aggressive signals – finger pointing, sustained eye contact, arms folded, hands on hips are all gestures which heighten tension rather than reduce it.
  • Deliberately adopt  “friendly” gestures – extending your arms with the palm of your hands outwards, dropping your shoulders, gentle voice tone, an open interview stance and your head to one side rather than full on – these will help to signal to the aggressor that you do not seek to be aggressive.

When you have managed to calm the aggressor to a point when you feel they are able to listen to you, then you can move into the next stage of building rapport.


This is really about winning the aggressor’s trust. If you are to gain effective control of the situation then it is crucial that the aggressor feels that he or she can trust you. This will involve showing empathy towards the aggressor.

This means letting the person know that you can appreciate his or her view of the world and the particular situation they are in. This is distinct from sympathy and agreeing that their view is the right one. Showing empathy can be achieved by simply reflecting back to the person what they have said.

Be careful not to use emotive words or phrases which emphasises failure of loss of face like:

“That was a pretty stupid way of carrying on wasn’t it?”

Show the individual that you are a person too. This may involve giving a little bit of yourself away to encourage the aggressor to talk and to be more open.

By this stage you should be dealing with a much more rational person who is amenable to reason and is listening to what you are saying. If you are not – then you need to continue with the “calming” skills until the person is able to be more rational.


Remember: Patients are not always right but they ARE important. Show them they are important by the way you treat them.




Dealing with Difficult / Angry / Aggresive Patients.

Difficult patients can often come in a wide variety. For some patients that         are being unhappy can  be:

  • Picky people                                                              
  • Know it all
  • Constant complainers
  • They will not listen to reason.

We have all come across someone who fits the above – and will continue to do so – but it is how we handle them that is the most important thing and even more important how we learn from it too.

But perhaps the most difficult for everyone is the angry patient. This is someone who feels that he or she has been wronged, and is upset and emotional about it.

These patients will often complain, they are angry – usually about something that you or the surgery did (or did not do!).

What are the answers to handling difficult patients? There is not right and wrong way. Each patient / situation is different and will be dealt with in various ways by staff. It is how you handle the complaint that could make all the difference.

Dealing with difficult patients may not only benefit you (honestly) it will benefit the surgery as well; Being confident  at handling difficult patients is an asset to the practice and a credit to you if done well.  It will help with your confidence when dealing with the next difficult patient.


  • Aggressive behaviour is competitive with an aim to win. Therefore someone usually has to lose.
  • This is usually achieved by putting others down or over-riding others feelings, wishes, or rights.
  • The aggressive person cannot see another person’s point of view.
  • Often the aggressive character responds with an outright attack. The aggressive person can resort to verbal or even physical abuse.
  • All this will leave behind a trial of hurt, anger or humiliated feeling.

Words and phrases often connected with aggression

  • Loud
  • Forceful
  • Out to “win”
  • Puts others down
  • Attacks when threatened
  • Verbal and physical
  • Arrogant
  • Unreasonable
  • Threatening
  • Overbearing
  • Inconsiderate
  • Abusive

Aggressive people make others feel

  • Defensive
  • Humiliated
  • Resentful
  • Revengeful
  • Aggressive
  • Upset
  • Afraid
  • Withdrawn
  • Hurt
  • Passive
  • Insecure

Dealing with difficult and aggressive patients will happen – but I am happy to say not as often as you probably think it will.

Be prepared to deal with each situation – if you feel you are not handling the situation very well or feel threatened ask someone else to step in and help.

But most important learn from each experience and take it forward in helping the next difficult situation.


If a patient is angry, never get angry back. It will only turn an unpleasant incident into something bigger. This then could turn to an official complaint.

Do not try logical argument on a patient in a temper. It will only add fuel to the fire.

Do not grovel, and do not let angry patients draw you into accepting their assumption that the practice is generally inefficient because of their single unhappy experience.

The way to deal with an angry customer is to apologise for the specific inconvenience only, and to take immediate action to put it right.

An angry patient in front of you means that you still have an opportunity to put it right. If the patient storms out of the surgery (or slams down the phone) make a note of it, if they made a complaint later on you may need to have evidence of this. (see blog The Incident Report Form http://wp.me/p1zPRQ-6o  )

If you can sort out the problem contact the patient and let them know that you have sorted it out. You often will find by this time they have completely calmed down.


Try not to get personally upset by the rudeness of an offensive patient. And do not fuel their abuse by making “value judgments” just stick to the facts.

Do not be deliberately causal or icily superior to show an offensive patient what you think of them.

The way to deal with the offensive patient is to keep cool, keep your professional detachment, stay polite and keep offering possible solutions in strictly factual terms.

Learn to ignore rudeness. Remember that the offensive patient is offensive to anyone that would have dealt with them. Your job is not to make them “nice” you simply have to supply them with what they came in for.

the point is that you do not have to make an angry person into  person – that is  impossible. All you have to do is get them to go away with whatever it was they came in to get – within reason.


Sometimes you do everything right, and that is still not enough for some people. You have put the right techniques into action, but the patient still remains difficult. In this instance you should bear in mind that:

  • Difficult patients are usually difficult for a reason.
  • Patients that are feeling, ill, scared or anxious are more likely to be difficult – and may remain difficult until their problem is resolved. This can often be a relative or carer of a patient.

Anxious patients can become childlike and have “tantrums”. Treating them like a child will encourage them to act like a child, whilst treating them like a responsible adult will encourage them to act rationally.

An example could be:

I understand your problem and I assure you I am trying everything to help you. Please take a seat and I will let you know as soon as I have any information”

This will be much more calming and effective than saying:

“I am doing all I can here. You will have to take a seat and wait your turn”

If people remain angry, it is often because they think that they are not being listened to.


  • Make an effort to look as if you are interested. Put your listening skills into action.
  • Particularly difficult patients may be “playing” to others around them. Perhaps take them into another room where they do not have the audience to “play” to.
  • You will gain the sympathy of other patients when dealing with a difficult patient.
  • Often other patients will try to help by arguing with or commenting on the behaviour of the difficult patient.
  • Whilst this might feel like a welcome help, remember that it is easy for the difficult person to feel even more threatened and aggressive.
  • If you have a very aggressive patient make sure that you have a barrier between you such as a desk.

If you feel that you are out of your depth ask the patient to take a seat and call on a senior member of staff.

Complete an incident form on any such occasion.

And remember if you carry out the above – more often than not the patient will calm down and apologise for the actions.

People who are unhappy with your service will tell ELEVEN other people and people that are happy will only tell FOUR. So make sure your patients leave happy!