Discover key strategies to understand and handle difficult patients as a doctor or medical student

Why do patients become ‘difficult’?

There is rarely a simple explanation for why patients or their relatives become difficult to deal with.

There are a patient’s existing circumstances, from before they entered our hospital or surgery:

  • Feeling unwell or in pain for a long time
  • Work or family worries
  • Financial hardship
  • Underlying mental health issues
  • Struggles with drug or alcohol misuse

Once in a clinical setting, they may well encounter further difficulties:

  • A long wait before being seen in clinic or A&E
  • A delay to diagnosis or treatment
  • Bad news about their condition that they were not expecting
  • Fear of doctors and medical settings

These negative contexts and experiences can produce negative emotions, like anger, anxiety, fear, and frustration. They may feel guilt at not having sought help earlier, either for themselves or others. These then spill out as difficult behaviour towards doctors, medical students and other health professionals.

Examples of difficult behaviour

Some behaviour is difficult but not harmful, presenting obstacles to doctors trying to treat or diagnose. For example, patients may be unwilling or unable to communicate their symptoms or how they are really feeling.

More serious is when patients or relatives experiencing anger become physically aggressive, presenting a danger to doctors. This may include physical assault, throwing objects, property damage, or self-harming behaviours.

Not all aggression is physical. Verbal threats and insults still cause very real emotional distress, and may still progress towards physical violence.

Strategies for dealing with difficult patients

As a doctor or medical student, your own mental state and behaviour can have an influence on whether patients are “difficult”. This is not to blame doctors for patient aggression, but it is true that we are more likely to get into a disagreement when we are depleted ourselves. So it’s important to recognise the signs and try to deal with stress and pressure as best you can.

Preparation is key. NHS staff should receive training in conflict resolution and dealing with aggression, though provision is varied. If you know this is lacking in your workplace, you might be able to advocate for it, especially if you are more senior.

When incidents of aggression arise, try to stay calm within yourself. It is not easy to predict how the other person will react in this situation, so focus on what you can control – your own actions.

Remember that patients should not be denied care or treatment just because they are violent or aggressive. However, this does not extend to racist or discriminatory patients.

Racist or discriminatory patients

Though the UK is a multicultural society, racist attitudes unfortunately still exist. Ethnic minority doctors and healthcare staff may be subject to racism from some patients. Doctors can sadly also face abuse for their gender, sexuality, religion, disability, or other reasons.

If you are the victim of racism or discrimination, or witness this behaviour, you should make a written note of what was said or done and report the behaviour so it can be investigated according to your workplace policy.

It’s important to note that ill health is not an excuse for discriminatory behaviour, and the NHS has a zero-tolerance campaign in place against all violence and intimidation of staff.

The NHS England website has information on violence prevention and safety.

What to do if you need support

Being a doctor is stressful even without encountering difficult behaviour from patients. It is normal to feel taken aback or shaken up after a tough incident, and they can exacerbate anxiety, stress and burnout.

It can help to talk to a colleague on your team about how you’re feeling. Your workplace may offer dedicated support services, or you can talk to your GP or an occupational health professional.

The RMBF also has resources for doctors in need of support:

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