Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

The world of elective medical practice is not without its challenges, especially when it comes to dealing with difficult patients. These individuals might be unruly, constantly dissatisfied, or even excessively litigious. While such patients represent only a minority, they can still create substantial problems in the practice, taking up valuable time and resources. This guide aims to explore the best practices for dealing with these patients, with an emphasis on risk reduction and steps to dismiss them if necessary.

Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

Identifying Difficult Patients

1. Recognize the Signs

Understanding the signs of a potentially problematic patient is essential in risk reduction. These may include:

Unreasonable demands or expectations

A history of multiple lawsuits

Consistent dissatisfaction with medical services

Aggressive or disruptive behavior

Reference: Haas, L.J., Leiser, J.P., Magill, M.K., & Sanyer, O.N. (2005). Management of the difficult patient. American Family Physician, 72(10), 2063-2068.

2. Screen Patients Before Acceptance

A thorough screening process that includes a review of medical history, consultation, and a clear communication of policies can prevent potential issues down the line.

Strategies for Managing Difficult Patients

3. Clear Communication

Set clear expectations for treatment outcomes and the patient’s responsibilities. Regularly update them about their progress.

4. Maintain Professionalism

Always interact with a patient in a calm and respectful manner, even when faced with aggressive behavior.

5. Document Thoroughly

Keep detailed records of all interactions, including consent forms, treatment plans, and any instances of unruly behavior. This can be vital in the case of legal action.

Reference: Hickson, G.B., Federspiel, C.F., Pichert, J.W., Miller, C.S., Gauld-Jaeger, J., & Bost, P. (2002). Patient complaints and malpractice risk. JAMA, 287(22), 2951-2957.

Dismissing Patients from Practice

In some cases, dismissal may be the only option.

6. Know the Legal Grounds

Understand the legalities surrounding dismissal in your jurisdiction. This usually includes ensuring that dismissal will not lead to patient abandonment.

7. Develop a Written Policy

Have a clear written policy for patient dismissal and ensure that it is consistent with local regulations.

8. Provide Adequate Notice

Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

Before dismissal, provide a written notice to the patient, including the reason for dismissal and information on finding alternative care.

Reference: Duxbury, A. (2005). How to dismiss a patient. Family Practice Management, 12(3), 53-56.


Dealing with difficult patients in elective medical practice requires a multi-faceted approach. Recognizing the signs, maintaining open communication, following best practices, and, when necessary, dismissing patients in a lawful and respectful manner are key components in mitigating risk and maintaining a professional environment.

Investing in staff training and implementing the above strategies will not only help in managing difficult patients but also in enhancing the overall quality of care. It’s a balanced approach that respects the rights and needs of all parties involved.

By adopting these best practices, medical professionals can effectively navigate the challenges posed by difficult patients and maintain a practice that is both ethically sound and legally protected.

Certainly! Continuing the blog, we’ll now focus on implementing technology in patient management, fostering a positive patient-practitioner relationship, and handling online reviews and feedback, which are vital aspects of managing unruly or litigious patients.

Implementing Technology in Patient Management

9. Utilize Electronic Health Records (EHRs)

EHRs not only streamline the administrative process but also improve transparency with patients, offering them access to their medical information.

10. Implement Online Scheduling and Patient Portals

These tools can facilitate better patient engagement and satisfaction, reducing misunderstandings and enhancing communication.

Reference: Menachemi, N., & Collum, T. H. (2011). Benefits and drawbacks of electronic health record systems. Risk Management and Healthcare Policy, 4, 47-55.

Fostering a Positive Patient-Practitioner Relationship

11. Emphasize Empathy and Listening

Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

A positive relationship begins with understanding the patient’s perspective and showing empathy, even when disagreements arise.

12. Engage in Conflict Resolution

When conflicts do occur, proactive resolution strategies such as mediation can prevent escalation.

Reference: Street, R. L., Jr., Makoul, G., Arora, N. K., & Epstein, R. M. (2009). How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Education and Counseling, 74(3), 295-301.

Handling Online Reviews and Feedback

13. Monitor and Respond to Online Reviews

In an age where online reviews can influence public perception, it’s essential to monitor feedback and respond appropriately.

14. Encourage Positive Reviews

Request satisfied patients to share their experiences online. This not only improves the practice’s online presence but also offsets negative feedback from difficult patients.

Reference: Emmert, M., Meier, F., Pisch, F., & Sander, U. (2013). Physician choice making and characteristics associated with using physician-rating websites: cross-sectional study. Journal of Medical Internet Research, 15(8), e187.

Establishing a Legal Support System

15. Collaborate with Legal Experts

Having legal support ensures that all actions taken align with healthcare laws and regulations, reducing the risk of litigation.

16. Regularly Review Policies and Compliance

Periodic review of policies with legal counsel helps to ensure that the practice remains compliant with evolving regulations.

Reference: Hodge, J. G., Jr., Gostin, L. O., & Jacobson, P. D. (1999). Legal issues concerning electronic health information: privacy, quality, and liability. JAMA, 282(15), 1466-1471.

Comprehensive Staff Training

Keywords: Staff Training, Professional Development, Patient Engagement, Conflict Management

17. Regular Professional Development Sessions

Consistent training ensures that staff are equipped with the latest methods to handle difficult situations with patients.

18. Workshops on Conflict Management

Offering workshops focused on managing conflicts can build a resilient team capable of handling unruly behavior.

Reference: Chant, S., Jenkinson, T., Randle, J., & Russell, G. (2002). Communication skills training in healthcare: a review of the literature. Nurse Education Today, 22(3), 189-202.

Patient Education and Involvement

19. Educate Patients about Procedures and Risks

Clear explanations of procedures, potential risks, and outcomes can reduce misunderstandings and dissatisfaction.

20. Encourage Shared Decision Making

Inviting patients to be part of the decision-making process fosters trust and satisfaction.

Reference: Charles, C., Gafni, A., & Whelan, T. (1997). Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science & Medicine, 44(5), 681-692.

Engaging Support Groups and Counseling

Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

21. Refer to Support Groups

Sometimes, difficulties arise from emotional distress. Referring patients to support groups can provide them with peer understanding and relief.

22. Offer Counseling Services

Counseling can address underlying issues that may cause a patient’s disruptive behavior.

Reference: Uitterhoeve, R., et al. (2004). Psychosocial interventions for patients with advanced cancer – a systematic review of the literature. British Journal of Cancer, 91(6), 1050-1062.

Embracing a Proactive Approach

Mitigating Risk and Managing Difficult Patients in an Elective Medical Practice: A Comprehensive Guide

23. Implement Preventive Measures

Prevention is always better than reaction. Adopting strategies that pre-emptively handle issues can lead to better patient management.

24. Evaluate Patient Satisfaction Regularly

Regular assessments of patient satisfaction can reveal underlying issues before they escalate.

Reference: Cleary, P.D., & McNeil, B.J. (1988). Patient satisfaction as an indicator of quality care. Inquiry, 25(1), 25-36.

The landscape of dealing with difficult patients in elective medical practice is complex, but not insurmountable. By combining a wide array of strategies from staff training and patient education to support groups and a proactive approach, practices can create a harmonious environment conducive to patient satisfaction and excellence in care.

These comprehensive guidelines not only help in managing unruly or litigious patients but lay the foundation for a patient-centered culture. The integration of legal, ethical, technological, and human elements is essential for the sustainable growth and reputation of the practice.

The best medical care doesn’t only lie in the procedures and technologies used but in the relationships built with patients, even the most challenging ones. Taking these steps ensures that practices not only comply with the legal framework but also align with the highest standards of medical professionalism.

Dealing with difficult patients, especially in an elective medical practice, demands a nuanced, multifaceted approach. By combining clear communication, technological advances, empathy, a focus on positive online presence, and strong legal support, practices can mitigate risks, foster a supportive environment, and maintain a high standard of care. This not only helps in dealing with unruly or litigious patients but enhances the overall patient experience, contributing to the success and reputation of the practice.

By investing in these areas, elective medical practices can create a balanced, legally compliant, and patient-centered approach that stands up to the challenges of modern healthcare.

Scroll to Top