What can physicians do to navigate the most challenging patient interactions? Here are 6 practices that physicians can adopt to ease tensions and make the most of their time with patients.

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Communicate with colleagues

One of the best ways to relieve tension and stress in the middle of a sticky situation is to talk it out. Who better to do that with than someone who intimately understands the weight of the job?

Physicians can also relieve themselves of sole responsibility for a patient by referring them to a doctor specialising in a complementary skill set, opening the door to a dialogue about the patient and each clinician’s experiences with that individual.  Talking takes time but physicians may find it time well spent.

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Build relationships

Although fostering bonds with patients doesn’t happen overnight, physicians can immediately improve the experience by not admonishing patients for questionable behaviours, according to the SAGE Open study.

It’s no wonder why physicians get frustrated when patients miss appointments, engage in risky activities or refuse to follow recommendations. But healthy, sustainable patient relationships require doctors to follow their patients’ cues.

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Set reasonable expectations

Physicians may benefit from scrapping their grand, “ideal” vision of patient treatment and replacing it with a series of smaller goals for patients to gradually meet, according to the SAGE Open study.

Start by encouraging patients to address one aspect of their health per appointment, such as improving their relationship with food. That’s more manageable for the patient than giving them a checklist that also includes quitting smoking and exercising daily. When patients are more receptive to care, they feel less discouraged and upset overall. The same goes for physicians.

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Notice skill deficits

If the exam room is clouded by heavy emotions, doctors can be mindful of their patients’ skill deficits, as noted in an article published in the AMA Journal of Ethics.

The case study uses the example of a “difficult” patient to provide physicians with advice on repairing doctor-patient relationships. When a patient gets heated, the authors note, it may be a result of their inability to regulate emotions during stressful situations. That patient might rely on their doctor, a substance, or another external source to wind down.

Physicians who consider these factors are more likely to step back and approach the patient with kindness and greater motivation to serve, instead of fueling the fire with anger or judgment.

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Contextualise to empathise

In the words of Jodi Halpern, MD, PhD, chancellor’s chair and professor of bioethics at UC Berkeley,

Empathy is,

"Not only spontaneous emotional attunement … but also a conscious process of cultivating curiosity about another’s distinct perspective.”

To access empathy in a hostile conversation, physicians can return to the basics, according to the AMA Journal of Ethics article. A patient sees a doctor because they have a problem. If the patient doesn’t feel seen, heard, or adequately treated by the doctor, they might resort to inappropriate behaviours, such as yelling which can be effective.

The doctor can react or calmly address the patient’s concerns and offer a new plan to meet their needs. This way, the patient walks away feeling validated and driven to keep trying. 

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Strategise from now on

The final step doctors can take to avoid a difficult patient interaction is strategic communication and collaborative planning for the future.

Physicians can focus on the positives before a visit starts, even if a patient regularly misses appointments, experts say. It’s key to avoid setting a harsh tone that may colour the rest of the appointment.

Doctors can also suggest different approaches to better meet their patient’s needs, such as developing a scheduling plan to prevent missed appointments.

Finally, physicians can ask their patients to lay out a list of goals over the course of a few months. This incentivises self-care and commitment to appointments, all while maintaining peace in the exam room.

This story is contributed by Jules Murtha and is a part of our Global Content Initiative, where we feature selected stories from our Global network which we believe would be most useful and informative to our doctor members.