How To Resolve Conflict With Difficult Patients

By John V. Guiliana, DPM, MS

   Out of the many challenges that business owners face day to day, human conflict is the one that most people lack the skill to handle appropriately. However, learning how to deal with interpersonal conflicts caused by “difficult people” will help enhance patient satisfaction and ultimately improve the productivity of your practice.    We perceive the “difficult person” in many different ways. He or she may be arrogant, demanding, unrealistic or condescending. Usually, the difficult person is someone who is working from the negative side of his or her personality. Such people are often unaware of how they affect others. Rarely do people make conscious decisions to be difficult.    In the business world, we are constantly faced with trying to work with others who may challenge our ability to get things done. There is great value to be gained when we take the time to try to understand another’s viewpoint. By changing our attitude toward difficult people or patients and changing our viewpoint about what makes them “difficult,” we can find a wealth of knowledge to improve our own ability to work with people.

Emphasizing Empathy And Identifying Primary Emotions

   An angry person needs to have the issue and his or her feelings addressed in order to start interacting constructively. The angrier the person, the more important it is to acknowledge his or her anger. Listening carefully and responding initially with empathetic statements is important before moving on to the issue. Problem solving with angry people often results in wasted time unless they are ready to participate calmly.    Resolving a conflict often begins and ends with listening. Successful active listening leads to a sense of empathy of the other person’s needs and position. Demonstrating empathy helps break down the barriers that preclude an amicable outcome.    During a dispute, actively listen for the primary emotions of the person. Common primary emotions include confusion, frustration, anxiety, loss of control and self-esteem issues. Anger is usually a secondary emotion. These buried primary emotions are often revealed if we just let the other person speak. By identifying and empathizing with those feelings, we may then be able to paraphrase the primary emotion back to the person accurately. This results in a bridge of understanding.    In a managed care environment, loss of control is often a root cause of anger. As a result, the receptionist’s post is often referred to as “the hot seat” in many practices. Health issues and fear of the unknown lower a person’s threshold for anger, potentially precipitating a conflict. Condescending people are often manifesting self-esteem issues. Podiatrists and their staff must address these various underlying causes before defusing a conflict.    Difficult behavior is designed to affect you emotionally so you will become aggressive or defensive. When we lose our cool and defend ourselves or become aggressive, we actually end up doing what the other person wants us to do. We lose because we enter into an ugly game in which there are no winners. Self-control is critical. This means we must control our own behavior. You are entitled to be angry or upset if you choose. However, we can learn to control our behavior as well as the way that we express that anger or upset so something good comes from it.

Pertinent Pointers For Your Response

When responding to difficult people or patients, here are some key tips to keep in mind.    • When dealing with someone who is attempting to provoke a confrontation, make a conscious attempt to slow down your responses. Do not reply immediately since your first gut level response is likely to be an angry or defensive one. Before you respond, ask yourself this question: “How can I deal with this situation in such a way that I create less anger and upset on both sides?” Then respond.    • Pay special attention to the speed and volume of your speech. When people get excited, they tend to speak quicker and louder and that causes the other person to escalate as well. As the conversation increases in speed, there is less and less thought, and more chance that people will say things that are destructive. Take your time.    • If you are really angered at what is being said to you, it is a good idea to take a time-out. A time-out is not avoidance and should not be perceived as such. How you preface the time-out makes all the difference. For example, if you say: “I’m not talking about this with you,” the other person will likely feel brushed off and this will make the situation worse. A better preface for the time-out might be: “It is not a good time for me to talk about this but I would like to discuss it with you tomorrow. Can we set up a time to meet?”

A Positive Approach Is The Best Approach

   There is a general principle in life that when you have more of an increased focus on things, you get more out of them. Accordingly, when someone is behaving in a provoking manner, you have a choice as to whether you talk about the “junk” and “bait” (designed to keep you off guard) or whether you talk about something constructive.    If you focus on side issues such as personal attacks, negativity and insulting comments, then that is what the conversation will be about. If you turn the conversation toward something constructive and avoid focusing on the confrontational comments, you do not allow the attacking person a forum to continue the attacks. He or she will simply lose interest in trying to put you down.    Language is an exceedingly powerful tool. Whether you communicate orally or in writing, the way you express yourself will affect whether your message is received positively or negatively. Even when you are conveying unpleasant news, you can soften the impact by using positive language. Negative phrasing and language often have the following characteristics.    • It tells the recipient what cannot be done.    • It has a subtle tone of blame.    • It includes words like can’t, won’t, unable to and other words that tell the patient what the practice cannot fulfill.    • It does not stress positive actions or possible solutions. Positive phrasing and language have the following qualities.    • It tells the patient what can be done.    • It suggests alternatives and choices available to the patient.    • It sounds helpful and encouraging rather than bureaucratic.    • It stresses positive actions and positive consequences that one can anticipate.

How To Avoid Negative Language And Phrasing

   If you want to move toward more positive communication, the first task is to identify and eliminate common negative phrasing. The following are quite common phrases that one should avoid whenever possible.    Expressions that suggest carelessness include “You neglected to get,” “You failed to” and “You overlooked.”    Phrases that suggest the person is lying include “You claim that,” “You say that” and “You state that.”    Expressions that imply that the person is not intelligent include “I cannot see how you,” “I fail to understand” and “I am at a loss to know.”    Demanding phrases that imply coercion/pressure include “You should,” “You ought to,” “You must,” “We must ask you” and “We must insist.”    Phrases that might be interpreted as sarcastic or patronizing include “No doubt,” “We will thank you to” and “You understand of course.”    If you are going to eliminate negative phrases, you will need to replace them with more positive ways of conveying the same information. Below are a few examples of positive phrasing.    • If you can send us (whatever), we can complete the …    • It seems that you have a different viewpoint on this issue. Let me explain our perspective.    • Might we suggest that you (suggestion).    • One option open to you is (option).    • We can help you to (whatever) if you can send us (whatever).    Developing a habit of using positive statements rather than negative ones is often a barrier breaking strategy in resolving conflicts.

Don’t Take The Bait Of Confrontational Behaviors

   The term “bait” refers to the many confrontational behaviors that have a single purpose: to control and manipulate you into responding in emotional ways. When you take the bait, the person basically reels you in since you have given up control of the conversation.    Let the bait go by. In most cases, the bait has little or nothing to do with whatever is being discussed but is a conversational control ploy. When responding, one tactic is to acknowledge the other person’s feelings and then refocus or move on to the issue. For example:    Patient: “I don’t think that you are competent in filing my insurance claims. Let’s face it. This is the worst office I have ever seen.”    Receptionist: “I know that you are frustrated about this. However, let us move back to solving the problem for you … Here is what I would like to do … .“    In this example, the receptionist has basically ignored the attack (bait), acknowledged the patient’s primary emotion and has refocused the conversation back to the issue and a possible solution.

When And How To Be Assertive

   Although you should avoid being manipulative, passive or aggressive, it is important to be assertive. You have a right to take action or impose consequences in situations when someone has stepped over the line in his or her comments or behaviors. In fact, if you do not speak up for yourself in these situations, some people will perceive you as an acceptable victim for their poor behavior. When using assertive type statements or setting up consequences, do not dwell on the manner in which the person is communicating any more than necessary. Make your statement and then refocus the conversation back to the issue.     “Mr. Jones, I will help you sort this out. In order to help you, I need you to slow down and answer a few questions so we can get this done.”    Notice that the above statement is firm, clear and assertive. If Mr. Jones persists in being nasty and making personal attacks, the receptionist is within her or his rights to say:     “Mr. Jones, if you can answer my questions, I can help you get your claim properly filed out. If you continue to raise your voice, I am going to have to ask you to leave. Which would you prefer?”

When A Win-Win Scenario May Not Be Realistic

   Your efforts should be focused on solving a problem, not “taking care of” a difficult person. If you insist on one “winner,” there probably will not be a winner and it may not be you.    During most conflicts with difficult people, we tend to search for a way to win. A win-lose strategy is often a failed one unless the long-term relationship with the other party is no longer valued. Preferably, one should employ a win-win strategy. In this strategy, each side makes concessions. For example, you solve the patient’s problem, he or she calms down and eventually sees your side. You should use this type of strategy in all conflicts in which you value the relationship with the person.    Occasionally, when a win-win solution is unrealistic and the relationship with the person is very important, one should consider a “lose-win” relationship. If you have ever refunded a difficult patient for orthotics that he or she was not pleased with in order to maintain your relationship, you have employed a lose-win strategy.

Be Aware Of What Your Body Is Saying

   Studies show that most of communication is based on what people see rather than hear. Your words account for only about 38 percent of the messages you convey. The remaining 62 percent is non-verbal. Think about it. In the practice setting, patients can see what you are not saying. If your body language does not match your words, you might be wasting your time.    Eye contact is the most obvious way that you communicate. When you are looking at the other person, you show interest. When you fail to make eye contact, you give the impression that the other person is of no importance. It could also mean that you lack confidence or are untruthful. Maintain eye contact about 60 percent of the time in order to look interested but not aggressive. If this is hard for you, strive to improve upon this. It subtly conveys respect and facilitates respect in return.    Your mouth also gives subtle clues when you are not speaking. Mouth movements, such as pursing your lips or twisting them to one side, can indicate that you are thinking about what you are hearing or that you are holding something back.    The position of your head speaks to people. Keeping your head straight will make you appear self-assured and authoritative. People will take you seriously. Tilt your head to one side if you want to come across as friendly, open or sympathetic.    Your arm placement often suggests how receptive you are to thoughts and ideas. Arms crossed or folded over your chest say that you have shut other people out and have no interest in them or what they are saying. This position can also say, “I don’t agree with you.” Sure, you might just be cold. Unless you shiver at the same time, the person in front of you may get the wrong message.    Control your hands. Your hands should rest in front of the plane of your body and below the neck. Legs talk too. A lot of movement indicates nervousness. How and where you cross them tells others how you feel. The preferred positions for the polished professional are feet flat on the floor or legs crossed only at the ankles. Studies indicate that the least professional and most offensive position is resting one leg or ankle on top of your other knee. This position might be interpreted as arrogant.    Even the distance you keep from others is crucial if you want to establish good rapport. Standing too close or “in someone’s face” will mark you as pushy. Positioning yourself too far away will make you seem standoffish. Neither is what you want so find the happy medium. Different people have different comfort zones that should not be violated. Do what makes the other person feel comfortable. If the person with whom you are speaking keeps backing away from you, listen to that cue.    Conflict resolution involves comprehensive use of eyes, ears, mouth and body. With practice, one can use this important business skill to enhance patient satisfaction, staff productivity and even your bottom line. Dr. Guiliana is a nationally recognized speaker and author on topics pertaining to medical practice management. He holds a master’s degree in healthcare management and is a Trustee of the American Academy of Podiatric Practice Management. He practices in Hackettstown, N.J.


As I read this I was thinking how I do come offf as a supervisor or facilitating IDT every other week. I am aware that I do not hide my feelings well and tend to respond to other people's challenging communication rather up front. But I am wprking more to be aware of my facial, body and verbal language. But also to be aware of my thoughts before opening my mouth. Also, not to respond and sometimes check in with another collegue works when I can do it. there are challenges with people I work with and also supervise!!

Amazing article! Thanks so much!

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