Dealing with difficult patient behaviour

No doubt, most of your working day in general practice reception involves many wonderful patients who appreciate your help and support.

But chances are you have also had run-ins with difficult patients.

Why difficult patient behaviour matters

The problem with these patients is that they not only make staff feel frustrated and personally attacked, they ruin the experience for other patients who are present.

Recognising five common types of difficult behaviour

In their article called “Customers from Hell”, Zemke and Anderson categorise difficult behaviour into five categories. From here, training can be developed to help frontline staff manage with these difficult people.

Demanding special treatment

Egocentric Edgar KNOWS he is better than other patients and you are here to serve him, and serve him well. But if you are just a lowly frontline staff member, he’ll probably want to speak to someone important, someone who runs the show.

Edgar will try to make your service staff feel incompetent ‘speed bumps’.

Swearing and abuse

Bad-Mouth Betty has a bee in her bonnet. Even though you try to calmly explain the process or the fairness of the policy, Betty may get frustrated and impatient and want to mouth off to you and everyone around her.

Betty is loud, vulgar and has a low opinion of you and your organisation (and probably of herself as well).

Angry outbursts

Hysterical Harold is the adult version of a two-year-old. He may get so indignant that his nose will become flushed, capillaries across his cheeks will burst, from the sides of his neck, fins will emerge. He may appear to be about to have a coronary.

Telling staff how to do their job

Dictatorial Derek knows exactly how to do your job and everybody else’s. He is an expert. He has seen it and done it all before. He may try to write it down for you and request you follow his instructions.

Wanting something for nothing

Freeloading Freda wants things for free. She’ll eat a whole meal at your restaurant and then complain of the quality. She’ll buy a new outfit, wear it to the event, then try to return it, even though it’s covered in wine stains.

How to respond to each type of difficult behaviour

How to Deal with Edgar
While Edgar seems to have the hide of an elephant and huge ego to match, it’s important to understand that ego and insecurity are very closely linked. His ego is your key.

To deal with Edgar, don’t let him undermine your self-esteem, but you can do this by making him feel that he is receiving superior treatment, even when he is not. For example, you could say, “I can do xxx, just for you Mr Edgar.” Even if xxx is standard policy.

How to Deal with Betty
Because she is polluting the servicescape with her obscenities, get her offstage if you can. Move her to a quieter area to discuss her concerns, with a colleague present and a clear way out. Then, ignore the crudities and try to ascertain the exact nature of her complaint.

Use selective agreement where possible. That is, agree with things she says that are fair and accurate, but don’t agree with outrageous or personal attacks on other staff or the organisation as a whole. Finding common ground may help defuse this bomb.

If she doesn’t settle, let her know you are happy to listen and try to resolve her issue, but warn her that you don’t need to listen to her foul language. If she persists, walk away or have her escorted out, and use your duress alarm if you feel unsafe. It is okay to teach her where the boundary of acceptable behaviour lies.

How to Deal with Harold
Harold needs to ventilate. Again, take him offstage and let him air it. Nod, stay calm, agree where you can, then most importantly, offer a solution. And quick. Before he starts weeping. He will expect you to attack back, thinking he’s picked a fight that surely he has a right to win. Kill him with kindness instead. It’s the biggest surprise of all.

How to Deal with Derek
Derek shouldn’t be given special treatment or favours just because of his personality. Ascertain what he is looking to achieve rather than the method. Say that, “yes, I can do that for you” or, “it’s not legal to do xxx.”

If possible, fulfil his request in the most appropriate manner and as quickly as possible.

How to Deal with Freda
Have clear communication as to returns policy. If you’re a restaurant, have waiters check during the meal how well it is being enjoyed.

The good thing is that most people believe they should pay for goods and services they receive. Freda is an exception, not the norm. The worst thing your organisation can do is over-bureaucratise your systems and processes in an attempt to thwart Freda and make it arduous for everyone else.

This can damage your brand equity and reputation. If need be, let Freda have her way.

Why personas help staff

It takes skill (and stamina) to deal with difficult people, day in, day out. By using ‘personas’ it is a way for staff to recognise common behaviour patterns and construct training methods for dealing with typical scenarios.

It also de-personalises what frontline staff can take very personally. It shouldn’t be personal. Nasty patients are just ‘another Edgar’ or ‘Hysterical Harold’, and nothing to get too invested in.

On the other side, when you can effectively deal with these five difficult patients, you will become their favourite staff member. They may only want to deal with you.

Do you have certain kinds of difficult patients? How do you deal with them?

Sources

• Zemke, R. and Anderson, K. (1990). Customers from hell. Training, pp. 25–31.
• The Royal Australian College of General Practitioners. Preventing and managing patient aggression and violence.