How to deal with “problem” patients at your healthcare practice

All healthcare providers and care teams will encounter a “problem” patient at some point. Patients with personality disorders may occasionally present challenges with boundaries, and chronic self-diagnosers can be resistant to treatment or prescription recommendations.

Problem patients create stress for office staff and distract clinicians. In fact, one study found that doctors make more diagnostic errors when dealing with difficult patients compared to neutral patients. Disgruntled patients are likely to broadcast their displeasure online by writing a poor review or logging a patient complaint. These negative testimonials hurt your ability to attract new patients, particularly if you don’t proactively monitor and manage your online reputation.

Fortunately, there are methods to effectively care for a problem patient that you can employ to increase satisfaction and boost patient retention.

In order to deal with a difficult patient, intuition, communication, and quick thinking are key. In chapter 288 of Clinical Methods, author Steven A. Cohen-Cole advises doctors suggests using a 3-function model during difficult patient encounters. The model includes:

According to Cohen-Cole, patients can be problematic for different reasons, and what works to soothe one patient might infuriate another. In this article, we discuss a few types of problem patients and management skills to help you handle them.

The most common type of problem patient is the angry patient. Patients can be angry for a variety of reasons, some of which have nothing to do with their experience at your healthcare practice. Often, angry patients are unnecessarily rude or disrespectful to office staff or primary care providers.

It is natural to feel upset or become defensive when a patient directs their anger toward you. But angry patients don’t want to be told that they’re incorrect or that their behavior is not appropriate. Rather, they want to be heard.

To deal with the angry patient, first take a moment to collect yourself. Try taking a few deep breaths or even leaving the room to create some space. Once you feel level-headed, acknowledge the patient’s grievances. Apologize without admitting fault — similar to how you would respond to a negative online review — and ask how the patient thinks the matter would be best resolved. For example, you could say, “I understand you’re angry. What can I do to help you feel understood?”

Flaky patients might not argue or make a scene in the waiting room, but they’re bad for business nonetheless.

Patients who are late throw off your schedule. When this happens, the best-case scenario is that you spend a little less time with them. The worst-case scenario is that you run behind for the rest of the day, which could irritate patients who arrive on time and compromise your practice revenue.

Patients who no-show have an even bigger impact. On average, practices lose $22,872 per year from missed appointments, according to Tebra research. Among respondents, providers had an average of 14 missed appointments per month. Primary care providers reported the highest cancellation rate (43%), followed by those in mental health (20%) and specialist care (14%).

One intervention for no-shows, last-minute cancellations, and late arrivals is to introduce a strong no-show policy. While financial penalties may be off-putting to some patients, they can also help to protect your practice revenue, particularly if they demonstrate empathy along with clear guidelines.

A better way to deal with late and no-show patients is to keep them from missing their appointments in the first place. Try automating emails, SMS confirmations, and follow-up reminders to help keep their appointments at the top of their minds while protecting your time.

According to Tebra’s 2025 Patient Perspectives survey, 47% of patients say that appointment reminders as a digital tool that make a big difference in their experience as patients. And 48% prefer to receive those reminders as text messages, while 41% prefer texts for reminders to book.

Your practice can also offer patients the ability to schedule and reschedule appointments online. This allows them to avoid calling the office during business hours and to be proactive about rebooking. According to Tebra research, the ability to reschedule online would help 75% of patients show up for more appointments.

Drs. Google, TikTok, and ChatGPT don’t usually provide an accurate health assessment, but that doesn’t stop patients from going online to look for answers to their medical woes. According to Tebra research, 88% of Americans have used online platforms for medical advice in the past year rather than consulting a doctor.

Patients who self-diagnose can be frustrating. They can undermine your authority by insisting on tests that aren’t necessary or treatment plans that may not be effective. But, like angry patients, self-diagnosing patients don’t usually like to hear they’re wrong. They might also have past experiences that make it harder for them to trust your expertise and care.

A better course of action is to listen attentively to what they found. After you’ve heard the patient out and completed a full examination, share your diagnosis and treatment plan, and thoroughly explain how you reached your conclusions. Without being patronizing, let the patient know that you don’t believe a particular test or procedure is necessary.

Then, you can be part of their informed decision-making about the recommended treatment or medication. You might also consider directing them to reputable online resources that can back you up and support continued patient safety.

Unfortunately, with many experiencing distressing situations in the healthcare system, some people dread going to the doctor. Whether they’re worried about a condition, fearful of possible treatment, or diagnosed with a mental health condition, these patients can be classified as anxious.

Some anxious patients will cry or shake. Others display their anxiety in more subtle ways, such as avoiding eye contact or fidgeting. Anxious patients can be too distressed to express their health concerns or to fully absorb important information you give regarding their care. Offering your patients the option to connect with you via telehealth may even make them more comfortable with sharing their concerns.

To effectively care for anxious patients, first assure them that patient safety is your priority and that, under your care, they are in good hands. Remind them that you specialize in this area of medicine because you want to help individuals just like them. They’ll need to feel supported in order to fully comprehend their medical care.

When appropriate, offer sympathy. If you are treating a patient with a chronic condition, for example, you could say, “I’m sorry you have to go through this. I know it’s tough, but it’s important to remain hopeful.”

Finally, let them know they can contact you at any time to ask questions, discuss their concerns, or for decision-making support. According to Tebra research, 40% of patients say that secure messaging with the provider is a digital tool that would make a big difference in their experience as a patient. Enabling two-way messaging within your patient portal, integrated with your electronic health record, can help you to better support anxious patients.

Remember, every patient is unique, from their health needs to their communication style. Approach each appointment and person knowing that your bedside manner can make a big impact on their overall experience. Take the time to listen to their concerns and frustrations, regardless of whether they’re related to their health. There’s often a lot more going on in your patient’s life beyond what their medical records say. While diagnosing and prescribing are a large part of a PCP’s role, tailoring your approach for each individual is a huge part of patient care.

If you remember these patient management relational skills, you’ll be rewarded with higher patient retention and hopefully, an advocate who brings word-of-mouth referrals and new patients to your private practice.

Want to learn how Tebra can help your practice boost patient retention and grow? Book a personalized demo today.