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.
Fam Pract Manag. 2026;33(2):17-20
Author disclosure: no relevant financial relationships.
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
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