Practice Management Alert

Modulating your own body language and tone can go a long way in de-escalating tension.

Regardless of your practice’s specialty or your providers’ credentials, challenging patients are a mainstay of healthcare.

Before you feel driven to the brink with patients who burn your teammates’ biscuits, try these strategies from Maria Rita Genovese, MHA, CPC, PCS, from her presentation “Managing the Challenging Patient” at AAPC’s 2025 HEALTHCON, to better cope with tough patient shenanigans and manage interactions.

Note the Many Types of ‘Challenging’

There’s no single definition of “challenging” when it comes to patient behavior or interactions, and providers may have different thresholds of what they can handle or accommodate before feeling frustrated. A provider may find a patient challenging for clinical reasons or due to the interpersonal dynamic.

Sometimes patients’ bad behavior will disappear when they feel heard or seen. Patients who struggle with interpersonal dynamics or interactions may be struggling with mental health or mood or personality disorders. Patients may also present as “difficult” if they aren’t able to stay on top of their personal hygiene.

Patients who ramble or aren’t good communicators can be frustrating to work with. And providers may become exasperated if a patient mentions a new or developing issue as the provider is wrapping up the encounter, conflicting with the flow of the visit and maybe even the provider’s schedule that day.

Depending on the challenge the patient presents, providers and other office staff can try to anticipate the issues and facilitate a smoother patient visit for everyone.

Prepare in Advance

If you know a provider struggles with a certain patient, you can prepare in advance.

If the patient tends to throw off a provider’s day, then the scheduling staff can try to time the patient’s visit early in the morning — thus getting the visit over with — or toward the end of the day, so a longer encounter doesn’t cascade into the rest of the schedule.

Flagging the patient’s chart so the provider takes extra time to read the records beforehand can help the provider feel better prepared when the patient has a particularly complex or convoluted condition. That way they can approach the patient and situation gingerly and choose their words especially carefully, Genovese said.

Relying on established coping mechanisms can help a lot, too. Clinical and support staff who can establish and maintain boundaries with tough patients may find it easier to maintain their professionalism. Don’t be afraid to say no to a patient, Genovese said, but don’t lose your temper.

Going the extra mile to clarify expectations for clinical outcomes and financial obligations can be incredibly helpful, too. Establishing a thorough process for informed consent can make sure that medical staff and patients are all on the same page, eliminating potential surprises and the resulting distrust or hurt feelings.

Don’t forget that calming one’s own body can also help a lot. Take deep breaths before and during the interaction to help relax body language and modulate vocal tone.

Lean on Empathy

Most patients who bring bad vibes to a doctor’s office aren’t bad people — they may be frustrated, exasperated, misinformed, scared, or just having a hard time. A lot of times, patients — and people generally — just want to feel seen or heard.

When a provider or other practice staff focuses on the patient and listens carefully, the patient may drop their bad attitude; they may have been “acting out” just to ensure they received attention.

A patient who walks in demanding an MRI that day for their perceived problem, regardless of whether it’s medically necessary or appropriate — or of their payer’s preferences on prior authorizations for such services — may be frustrating for a clinician to deal with, Genovese noted. But being empathetic to the patient’s concern and calmy explaining the process for obtaining such services can help de-escalate tension.

In these situations, staff (especially physicians) who communicate directly and are empathetic to patients’ struggles can gain a lot of patient trust, she said. Also, try to avoid being judgmental or defensive. Providers can also empathize by selectively disclosing their own personal experiences, making patients feel a lot less alone in their experiences, especially if they’re struggling.

Ignoring or avoiding challenging patients won’t help defuse the situation or improve the relationship or patient satisfaction.

Striving for patience and tolerance, and even deploying gentle humor if it feels appropriate, can go a long way in dissipating any bad feelings. Patients may feel safer and more comfortable when medical staff pay attention to the speed, tone, and volume of their speech, and providers can feel better about tough interactions when they know they’re in full control of their own behavior.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC