Every patient deserves empathy and respect — even patients that, quite frankly, attempt to manipulate you.

Some manipulative patients simply want attention, while others may be seeking painkillers and other drugs. They may use flattery to try to gain your sympathy and — if that fails — resort to angry outbursts and threats of legal action to try to intimidate you into giving them what they want.

It’s essential that you have a plan in place for dealing with these kinds of patients. You will, without a doubt, encounter them eventually. To protect your reputation and your license from unfair accusations (just in case the patient makes good on his or her threat to report you to the Medical Board, no matter how unfairly), consider these steps:

  1. Use a treatment contract for patients who receive narcotics or other controlled substances. The contract should set out exactly how medication refills will be handled, how dosage increases will be managed, what happens if there’s a problem and what recourse the patient has.
  2. Make sure that your entire staff understands the policies regarding patient contracts and patient interactions. Ultimately, you are responsible for your staff — so take the time to educate each staff member of his or her role.
  3. Try to participate in shared decision-making with the patient. A patient who seems manipulative may just be angry and feel powerless. A shared decision-making process may change the dynamic for the better and alleviate the patient’s anger and fear.
  4. Don’t be afraid to address the “elephant in the room” with an angry or distressed patient. It’s okay to say, “This has been a difficult visit. Let’s schedule a follow-up to discuss what happened and come up with a better plan.”
  5. Have a termination plan. While this should be a final option, you need to have a plan in place that will allow you to terminate your relationship with your patient without endangering his or her health. If you’re unsure of what you need to do to protect yourself (and your license) seek experienced legal advice so that you avoid ethical violations.

Finally, remember this: You’re human. You can’t lose your temper with a patient, but you may need to take a personal time-out so you can vent; otherwise, let go of your feelings and get back to business.