Risk Management: Working with a Difficult Patient or Family Member

No matter in which area you work within Allied Health, you will at some point encounter the difficult patient. Difficult patients may include those who are argumentative, hostile or who are non-compliant with treatment. These patients may be in all settings--outpatient, inpatient as well as other types of settings. You may also be treating a minor and his/her parent may be difficult or may be involved in a difficult situation such as a divorce or custody battle. Here are a few tips to follow when encountering the difficult patient or family member.

    Maintain Professionalism
    It is important to always maintain professionalism when dealing with patients and families whether they are difficult or easy to manage. You certainly do not want to face a complaint to the licensing board or to your organization for lack of professionalism.

    In general, patients often will likely not file complaints or lawsuits against providers who maintain professional relationships, when they feel they are listened to, their concerns are addressed or if there is follow up in addressing their needs. If they feel you are rude, dismissive, or do not address their concerns, then they may be more inclined to file a complaint against you. Keep this in mind when interacting with your patient.

    Use a calm voice and maintain physical distance from the patient when a difficult situation arises. Attempt to de-escalate any situation, and if you need tips on how to deal with the patient, consider asking your supervisor, if you have one. Safety for all is always paramount. If you do not feel safe, you may need to consider calling 9-1-1. Having a plan prior to actually needing to implement it is always a good idea.

    Consultation and Supervision
    When you are unable to resolve an issue, consider talking with another professional to obtain advice on how to deal with the patient. Ongoing consultation and supervision may be a useful resource when dealing with a difficult patient. This may also assist you in proactively and effectively managing the patient.

    Informed Consent
    Informed consent is critical whether dealing with a difficult patient or not. If treating a difficult patient, you will want to make sure your records have informed consent documented, are up to date, and meet the legal and professional standards for record-keeping.

    Release of Records
    If you have a difficult patient encounter and your patient requests his or her medical records, either at the time or afterwards, consider contacting your insurer to advise. This is especially important if the patient threatens you with a board or legal complaint. If there is a difficult family member who requests records, make sure he/she has the legal authority to request and receive the record. It is important to have an office policy for release of records which allows you sufficient time to seek consultation and consider whether to release the records and, if so, to prepare them. Notify your patients when they begin treatment of your policy. However, the family member may not have been involved in the treatment and it may be necessary for you to inform him/her of the policy if you have permission to talk with the family member. It should be a consistent policy for all. Additionally, if your patient sees other providers, make sure you have the appropriate release signed by the patient to talk with other providers.

    If you are unable to continue treatment, you may need to consider ending the therapeutic relationship with the patient. It is important, however, to keep in mind your profession’s ethics code regarding patient abandonment and to be aware of any termination requirements within your state. There may be time requirements before you are able to end the relationship, but there also may be times when it is critical to immediately end the relationship due to safety or security issues. If you are ever faced with this, it is important to seek guidance. Again, having an ongoing consultation group or a trusted colleague with whom you can consult is highly recommended.

    Be Aware of Your Profession’s Ethics Code
    Your profession’s ethics code may provide guidance on ending treatment or dealing with a difficult patient. If you have questions or concerns, consider checking the ethic’s code to determine if there is any insight into the issue. Also, you may be able to find additional information on your profession’s national, regional or state website.

    Make sure you objectively document your interaction with the patient. Use quotes versus subjective information. For example, document patient’s statements or describe their physical posturing versus documenting a subjective statement such as “patient appeared threatening.

    Document thoroughly. Documentation may be helpful if you face a board complaint or a legal claim. It also may not be helpful – keep that in mind when documenting.

    Patient Privacy
    When treating a difficult patient or otherwise, it is always good practice to be mindful of your state rules and the rules under HIPAA for privacy and confidentiality and ensure they are adhered to.

    State Laws and Regulations
    Each state has its own set of laws and regulations. You should know what applies to you, and if you should need a regulation explained/interpreted, you might consider reaching out to an attorney for advice.

Author: Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM, Healthcare Practice and Risk Management Innovation Officer

NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of Trust Risk Management Services, Inc. is strictly prohibited.