High-Maintenance Patients


Don't let their bad behavior make you a bad doctor.

Fam Pract Manag. 2019 Jan-Feb;26(1):36.

Author disclosure: no relevant financial affiliations disclosed. Note: All patient names have been changed.

We all have them — patients who require a lot of our time and energy, not necessarily because they are sick but because they are hypochondriacal, needy, or entitled. The latter are the worst kind. They want what they want when they want it. They call with urgent demands and show up without an appointment. They belittle staff, and they feel they are different from everyone else so rules don't apply to them. They are pushy and, quite frankly, drive me nuts.

Susan was such a patient. She was married to William, another patient of mine who was also high maintenance and an enabler. Together they were hard to take and frequently called in for tests or medications without being seen. This time the call came from William, who wanted a referral for Susan to an endocrinologist. I knew she was on a lot of hormones — none of which I had prescribed for her. They went to a holistic practitioner who took care of her numerous meds and tests, half of which I rarely used or had never heard of before. Unfortunately, that practitioner had retired so I was called for the referral, which she wanted stat. She knew which endocrinologist she wanted to see, so — not wanting to be bothered with why — I had Dalia, my office manager, make the referral. For some reason it didn't go through, and Susan showed up at our door distraught and caused a scene in front of other patients. Susan later apologized by phone for this behavior, but when the second faxed referral apparently wasn't received by the endocrinologist's office, I got an email from William saying Dalia had treated Susan in a profoundly irresponsible manner, causing her and their family a great deal of emotional stress. He went on to say that Susan had attempted to contact me to inform me directly of the many incidents, but Dalia was intercepting the calls. My reply to him was succinct:

“I am sorry to hear that you are having a hard time with our office and Dalia. In all the years she has worked for me, I have never had one


Dr. Brown is a solo family physician living in Mendocino, Calif.

Author disclosure: no relevant financial affiliations disclosed. Note: All patient names have been changed.


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