Despite our best efforts, not all patients will interact with us in a healthy manner. Here's what to look out for and how to manage the most manipulative behaviors.
The goal of this article is to help you maximize patient interactions in which kindness and respect are reciprocal and foundational to patients achieving their best health outcomes.
In order to shift all your patient alliances in this direction, it is necessary to do the difficult work of minimizing toxic patient behaviors that spill into healthy relationships. This includes identifying the tells and traits of highly manipulative patients (HMPs) and learning how to respond to them, especially by declaring and strengthening your boundaries so that there will be no doubt that civility, dignity, and autonomy guide all patient relations.
KEY POINTS
- Set and communicate clear boundaries early with patients, using tools like previsit letters or videos to define expectations and explain what behaviors will not be tolerated.
- Stay firm, neutral, and consistent in responses by avoiding emotional engagement (e.g., using JADE and gray rock techniques) and redirecting conversations back to medical concerns.
- Protect yourself and your practice by documenting manipulative behaviors clearly, enforcing consequences for threats or violations, and grounding all decisions in medical necessity.
MOST PATIENT RELATIONSHIPS ARE HEALTHY
Relationships are iterative. Their key ingredients — understanding and accountability — grow in longitudinal contacts and are solidified by our presence when patients need us most.
Most patients respect our time and understand that we must share it with other patients. They accurately interpret our clinic policies and professional boundaries not as barriers, but as welcoming, low-friction channels for the genuine sharing that develops in safe and smooth relationships. As patients grow comfortable within these protected spaces, they freely share their authentic selves and gratitude. They accept and multiply our generosity of spirit, understand our limitations, and offer forgiveness for our mistakes. These relationships outlast the diseases we may or may not vanquish. For many of us, they are the best reasons to be a doctor.
There are many ways to build and maintain patient relationships. There is one sure way to lose them: to be unavailable when you are needed. And the fastest way to become unavailable to patients who are counting on you is to be absorbed into ever-demanding relationships with HMPs.
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