You’ve mentioned setting boundaries. What challenges do physicians face in doing that?

Many are afraid that patients will become angry or that the practice will get bad reviews. Although this might happen, the good that comes from setting boundaries outweighs these concerns. Again, remember that boundaries are also in the patient’s best interest.

What other strategies do you recommend?

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Have good communication skills, which includes listening to patients even when they are angry or when you feel they’re wrong.  If you find yourself becoming worked up, take deep breaths, slow down, and listen.

Some physicians are afraid that by being kind to angry patients they are actually condoning the patient’s inappropriate behavior. But on the contrary, creating a respectful environment can prevent a situation from escalating and further a smooth clinical encounter.

You have talked about patient factors but are there also physician factors that contribute to difficult patient encounters?

There are definitely factors that physicians and other providers bring to the table, including being tired and harried, angry and resentful, or arrogant and dogmatic. Physicians should strive to create personal balance, have a more feasible schedule, have adequate staffing, have adequate EHR support, utilize resilience and wellness services, engage in self-care, and pursue mental health treatment when necessary.

What practical tips can you suggest to reduce the risk of difficult patient encounters?

Be aware of language barriers and cultural issues, which can interfere with adequate physician-patient communication. As much as possible, have a conducive physical space that is comfortable, private, and not too noisy.

Have clear, easy-to-understand policies in place. (Table 2) All staff members should be aware of these policies.

You mentioned violent patients. How can violence be addressed?

While violence can potentially occur in any environment, it is most common in emergency departments, psychiatric units, the ICU, and the IMC. Be particularly aware of the potential for violence in high-risk patients and be cognizant of warning signs that a patient might be escalating in that direction. (Table 3)

While you may ultimately need to call security, physical restraint should be a last resort.


1. Jackson JL, Kroenke K. Difficult patient encounters in the ambulatory clinic: clinical predictors and outcomes. Arch Intern Med. 1999;16:689-700.

2. Krebs, EE, JM Garrett, TR Konrad. The difficult doctor? Characteristics of physicians who report frustration with patients: an analysis of survey data. BMC Health Services Research. 2006; 6:128

3. Hull SK, Broquet K. How to manage difficult patient encounters. Fam Pract Manag. 2007 Jun;14(6):30-4.