Managing the Most Difficult of Patients

“Let your soul stand cool and composed before a million universes.”
—Walt Whitman

Primary care providers interact with the full range of humanity—much of it on the positive end and occasionally, on the negative. Dealing effectively with difficult people is a life skill because without it, we can be robbed of our wellbeing, productivity, sleep, our kindness, and generosity. By far, the most challenging kind of person to deal has the following qualities:1

  • Acts from a strong send of entitlement
  • Acts as if the rules don’t apply to her/him
  • Has no regard for how they are perceived by others
  • Creates a strong sense of moral outrage in you

We all have “jerk” tendencies, behaviors that come out when stressed or feeling threatened. But these individuals stand alone in their consistent ability to rattle us. When working with challenging patients, you must save yourself and avoid the two equally destructive options. The first, resignation, is whenwe lose our own self-respect with a pathetic accommodation. The second, resistance, in when we fly into a rage, trying to get the person to listen to reason. Neither of these strategies comes from a place of empowerment. We must give up that good fight and follow these general rules:

1. Don’t try to change the difficult person, whatever you do. Their outlook is entrenched and your effort is futile. This person does not care what you think or may not fully acknowledge you as a person.

2. Cooperate only on your terms, you can’t get this person to change or to identify others as equals, so don’t even try. When dealing with difficult individuals, we are often fighting for recognition and there are few good constructive responses. If you must engage, only do so superficially; do not give them the time or energy you would with a more thoughtful person. Don’t get caught unaware, it can ruin your whole day.

3. Full disengagement is often the wisest course because we can’t strive to change that which we have no control over. Divert your will and your power to your true purpose. By holding back and only engaging on your terms for your own reasons, you can maintain civility and save yourself. If this person is not your patient, but a boss or has authority over you in some way, your best course may be to extract yourself.

—Eileen O’Grady, PhD, RN, NP


1. James A. Assholes: A Theory. New York, NY: Anchor Books; April 22, 2014.