Challenges in healthcare are the norm. However, some patients present significant challenges to healthcare professionals and the care environment that rise to the point of creating unnecessary risk. While healthcare providers and their staff should always attempt to resolve patient concerns, there comes a point when the best course of action may be to terminate the provider/patient relationship.

Some of the most common causes of conflict arise from the following scenarios:

  • Potentially violent patients, family members or friends
  • No-show patients — especially new ones
  • Potential and established patients unable to pay
  • Patients who don't follow treatment plans
  • Patients who refuse treatment options
  • Angry patients after a bad outcome

The Doctors Company, a medical malpractice carrier, offers advice to providers on preserving a constructive physician-patient relationship when patients behave in difficult or unreasonable ways.

Their guide "Managing Challenging Patient Relationships" was developed from lessons learned and offers techniques for managing several common patient scenarios. It also helps providers recognize those situations calling for patient termination and reviews the critical steps you should take to minimize risk.

Highlights from the guide are listed below starting with a core component establishing a practice safety plan.

1. Establish a practice safety plan, train staff and exercise it with various scenarios to reduce the risk of harm to providers, staff and patients. It should include measures to identify high-risk patients, training on response to identified vulnerabilities and adjustments to the environment.

2. Communication and listening to patients focused on resolving their concerns goes a long way toward diffusing many situations. Compassion and empathy, clarifying or resetting expectations, holding patients accountable for their role in care processes and finding common ground for a new path forward are important. At their core, patients just want to feel heard and respected.

3. Establish a formal policy on no-shows and include a disclaimer on both online and paper health questionnaires and other data collection tools. In this digital age, this will minimize risks associated with those who don't arrive for their appointment or leave before being scene especially if they have already provided health information.

4. Clearly communicate your practice's payment policy and consistently apply it in a nondiscriminatory manner for both new and existing patients.

5. Incorporate patient goals and actions into treatment planning and communicate them in a way that is easy for patients to understand and act upon. Be persistent and enlist family caregivers for support, as needed.

6. The informed consent process plays an important role in minimizing the risk that patients will be unhappy with an undesirable outcome. However, patients and family can still be unhappy with the outcome. Ensure that patients are informed of the risks of their treatment plan and/or treatment and provide educational content for reinforcement. For any procedures or treatments with significant risks, complete a practice informed consent form and have the patient sign that they understand the risks.

Termination of a patient relationship should not be a common occurrence. If it is deemed the proper course of action for safety and the therapeutic relationship, the guide provides recommended steps, including providing the patient with reasonable written notice and provisions for continued care.

While this guide was designed for medical providers, it will also help therapeutic and other healthcare practices reduce their business risk and minimize liability.