As I walked into my office on a typical Tuesday morning, my medical assistant gave me a familiar, knowing glance. I had arrived early, having overbooked my schedule to accommodate one of those patients. You know the ones — our “VIP” list of difficult cases. While some patients end up on this list over time as their medical conditions evolve, others start off challenging from day one. These patients test our clinical expertise and our patience, pushing us to navigate complex diagnoses and coordinate intricate care plans. They consume extra time with prior authorizations, mountains of paperwork, and seemingly endless coordination of services.

Then there are those who derail our day emotionally, demanding and complaining about every perceived slight — whether it’s the manner in which the front desk handled their payment or the music in the phlebotomy lab. Some patients fall into the “noncompliant” category, showing up for every appointment but never adhering to the treatment plan, leaving us frustrated with the lack of progress. While it’s easy to label these patients as “difficult,” the truth is, aside from instances of outright violence or threats, each of these individuals has a story. The real question is: Are we, as clinicians, genuinely listening?

Navigating these complex relationships has been a journey for me as my clinic and team continue to grow. Much like in customer service, the entire patient experience matters — now more than ever in the era of online reviews and corporate surveys. Over time, I’ve identified three main triggers that tend to make certain patients more challenging than others. By better understanding the root causes of these behaviors, we can not only improve the patient experience but also find greater satisfaction in our own work — especially on the days we dread seeing particular names on our schedules.

1) The Fear of the Unknown

Fear of the unknown is a fundamental human response, especially when it comes to health. Whether it’s a life-altering diagnosis or a new, unfamiliar medication, patients often react with denial, defiance, or confusion. When they feel misunderstood or alone in their journey, their anxiety escalates, making it harder for them to absorb information and trust their physician. This fear is compounded when patients are in physical pain or feel dismissed. If we, as clinicians, appear rushed or unprepared for their questions, if we avoid eye contact or become defensive, it only intensifies the discomfort and fosters mistrust.

So how can we alleviate this fear? A few simple strategies can make a world of difference. First, we should provide patients with access to the same information we rely on — pathology reports, lab results, and imaging studies. This transparency can demystify our decision-making process and help them understand why we recommend certain treatments.

Additionally, educational handouts or links to reputable sources can provide clarity and reassurance. I often include these in an after-visit summary along with detailed medication instructions, next steps, and a follow-up plan. Having a clear, written outline can help patients feel more in control once they leave the office when the inevitable overwhelm sets in.

2) The Stress of Disorganization

It’s not just what happens in the exam room that shapes a patient’s experience. Many patients become frustrated and even rude when they encounter disorganization before they even see us. This can start as early as parking, finding the correct building, or navigating a complicated check-in process. Late arrivals due to unclear signage or long commutes leave patients flustered before the visit has even begun, which sets the tone for the rest of the encounter. Add to this the stress of managing multiple specialists, especially for those with complex medical conditions, and it’s no wonder some patients express their frustration as anger.

While we may not control our office’s location or parking situation, we can take steps to ease the burden of disorganization. Calling patients who are running late to offer assistance or rescheduling them for a telemedicine appointment if they’ve forgotten about their visit entirely can help mitigate the confusion. In my practice, when patients get lost, my team guides them by phone to ensure they feel supported.

I’ve also found that simply greeting a late-arriving patient with kindness instead of frustration significantly reduces the tension. When we accommodate their tardiness with understanding, patients are often more patient with any delays on our end.

3) Acknowledging Their Pain Points

In my experience as a rheumatologist, the most difficult patients are often those who feel misunderstood or dismissed. Some are upset about misdiagnoses, while others are grappling with major shifts in their diagnoses. Patients who have experienced trauma, whether medical or otherwise, often have difficulty trusting physicians, which makes it harder to build rapport and engage in shared decision-making. When patients feel their pain or concerns are being brushed aside, they may respond with confrontation or aggression as a means of asserting control.

How we handle these situations is critical. Acknowledging a patient’s pain, both physical and emotional, is the first step in earning their trust. While we may not always have the answers to their complex medical issues, we can at least provide the space for them to voice their concerns. In my practice, I’ve found that breaking up difficult conversations — especially those involving significant changes in diagnosis or treatment — into smaller, more frequent appointments can help. It may seem counterintuitive to see a difficult patient more often, but the increased face-time builds rapport and helps foster a more trusting relationship.

This approach works especially well with patients who are noncompliant or those who struggle to grasp the implications of their diagnosis. When changing or re-evaluating a diagnosis, it’s important to validate the patient’s previous experience. Gently acknowledging their journey, even if it was based on an incorrect or incomplete diagnosis, can soften the blow and make them feel heard rather than dismissed. Moving from the idea of illness to remission should be handled thoughtfully, with recognition of the patient’s past struggles, rather than an abrupt shift in tone.

Shifting Perspective

The next time you see a familiar name on your schedule that triggers a sense of dread, take a moment to reframe your mindset. Consider how that encounter could result in a positive outcome. Rather than bracing for another difficult interaction, think about what you can do to guide the patient toward better health and understanding. Remember, they are coming to you for help, even if their behavior suggests otherwise.

It’s possible that they aren’t trying to derail your day, but rather, they are seeking clarity, support, and a way to navigate their overwhelming health care experience. By listening more intently, providing clear information, and offering a little extra patience, you might find that, over time, these difficult patients become less challenging — and more successful in their health care goals.

How do you help "difficult" patients? Share in the comments.

Dr. Brittany Panico is a rheumatologist in Phoenix, AZ. She is a wife and mother of three awesome boys and enjoys hiking, being outdoors, traveling, and reading. She posts on @AZRheumDoc on Instagram and Brittany Panico, DO, on LinkedIn. Dr. Panico was a 2023–2024 Doximity Op-Med Fellow and continues as a 2024–2025 Doximity Op-Med Fellow.

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