Entitled patients: 6 ways to respond

You probably know patients who present with entitled attitudes and you may think there’s not much you can do about them.  Entitled patients often demand excessive attention and may question your competence when they are not satisfied with how important you make them feel.

By using one or more of the following approaches, you can manage entitled patients respectfully while reducing your risk of stress and burnout.

1. Be on the same side.  When an entitled patient brags about knowing your CEO, your best strategy is to praise your CEO with a lot of specifics.

“You know our CEO George Doria?  Isn’t he amazing?  At our weekly meetings, he’s the most down-to-earth guy.  He never fails to ask how my son is doing in baseball.”

The entitled person immediately sees that threatening to complain to the CEO is not going to intimidate you.  And it may dawn on him that you’re in a position to complain to the CEO about the entitled attitude he presented.

2. Use empathy to absorb tension.  George Thompson and Jerry Jenkins, authors of Verbal Judo, suggest: “Empathy Absorbs Tension.” Without an obvious demonstration of empathy, the entitled patient will view you as the obstacle to what she wants.

“I’m sure being here is taking time away from important things you need to do. I don’t like waiting either and know it’s frustrating. As soon as the doctor is available, I will immediately let you know.”

Subtle emphasis of “immediately” will convey that you understand the need for urgency.

3. Take patients as you find them.  Ten percent of the time, patients will be annoying.  If you allow that ten percent to control your entire day, you’re at greater risk for stress and burnout.  Consider acceptance as part of the patient’s treatment plan say Marian Stuart and Dr. Joseph Lieberman, authors of The Fifteen Minute Hour: Therapeutic Talk in Primary Care. Your tone of voice conveys how you really feel, so focus on making it non-judgmental.

“Let’s see what we can do to make this better.”

4. Focus on the person, not the personality. Make it a point to listen when you have time.  Everyone wants to feel unique and special.  What does the entitled person do when he is not there being your patient?  If he drops the names of the hottest restaurants, could you ask for advice for a special occasion coming up?  It isn’t easy to do this, but it may be just the technique that turns the entitled person into an easier patient.

5. Use the million-dollar phrase. Entitled people believe that what they want is fair, and when they can’t have what they want, they often react with criticism that is hurtful rather than constructive.

You need a safety net response to prevent situations from escalating out of control. Focus on slowing down your responses.  Pause before answering.

Listen to the criticism without interrupting or objecting.  Then with all the sincerity and respect you can muster, pull out your million-dollar phrase:

“Mr. Forbes, thank you for telling me.”

6. Find a team member to step in for you.  It can be interesting to learn that a patient behavior that drives your colleague crazy doesn’t bother you in the least, and vice versa.  Consider a non-verbal signal to alert a colleague to come over and help the entitled patient.  Remember to do the same for your colleague when his or her version of the difficult patient arrives.

Susan Keane Baker is a speaker specializing in physician-patient relationships.  She is the author of Managing Patient Expectations.

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  • meyati

    This is somewhat unrealistic to say the least. Is the author practicing in a barn or hotel lobby, where she can flag down a colleague to handle a difficult patient? If my doctor got on the phone or sent a nurse out, and strange people came in, I’d suspect the worst.If it wasn’t the worst prognosis, I’d be madder than hell if another doctor was in to explain why I needed to take thyroid or brush my teeth. I don’t know if I’m an entitled patient, but my veins start throbbing, when patronizing phrases are being used like “Let’s see what we can do to make this better”; “You are special to us,” etc. I also hate surveys that ask if the doctor is using terms that I understand.I hate baby talk and tell doctors that I’m an English major and I’ll question anything I don’t understand. I just had radiation treatment, and the techs told me how nice and cooperative I am. Many people become rigid and paralyzed from fear, kick or hit if moved, curse. After the third day, I hit the supports and guides almost perfectly. They called me “the fast food drive up”-in and out with a complete order. So maybe people act entitled because the medical staff isn’t clear and honest in talking to patients. I’d be really worried about the sanity of any doctor that asked me about dining recommendations, unless I had that doctor for years, and we had a friendship. There’s too much room for miscommunication as it is. The last visit, my PCP asked me if I was getting chemo or anytype of shots. I told him no. Then he asked me why I’m seeing Dr. B. I told him that in a couple of weeks that I’d have my CATs with contrast to see how effective the radiation was. He said that he just asked me if I was currently having treatment. I told I’m in a waiting period and not currently having treatment. Then I gave him the dates for radiation, CATs, etc. He came back from vacation-playing catch up-and the poor man forgot that I’m very literal. Next time, I’ll send a head’s up-Hi, I had radiation, date, Oh, hell.

    • Susan Baker

      Hello Meyati, thanks for taking time to send a response. People value experiences in which their unique preferences and identified and respected. Hopefully your physicians are taking time to learn your preferences. I hope your treatments go well for you and thanks again for writing. Susan Keane Baker

      • meyati

        Thank you Susan. I know that my doctors are often tired, and I’m not their only patient, but it is comforting to realize the doctor is listening to me. I don’t care to be redundant, and I address the issue at hand, so I try to be concise. Usually my PCP isn’t so harried. I need to make sure that he gets an update from my oncology team leader after the next visit.

  • Eileen

    This is a great article with lots of practical advice. Empathy truly does absorb tension. Empathy diffuses situations which could easily intensify and get blown out of proportion. I especially like the line, “Let’s see what we can do to make this better.” Whether I use that in my own work, or whether that approach is used on me, it diffuses angst and tension at once. Thanks again for such useful tips! Eileen

  • Cyndee Malowitz

    Considering there aren’t many primary care providers to go around, I’m surprised anyone would put up with a patient with an attitude. Seriously, if they don’t like it, they are more than welcome to seek care elsewhere.

    • Susan Baker

      Ahh Cyndee if only…. While some organizations are able to set clear and consistently-applied boundaries, most need to be able to respond to challenging people. I can’t see myself telling the hospital CEO’s wife that she can take her attitude elsewhere. Thanks for posting!

      • meyati

        In my world, it was usually a colonel’s new third wife. Problem was that everybody knew that a Sgt’s original wife had more power or the colonel’s girlfriend.

      • Suzi Q 38

        I agree. Maybe in her dreams, perhaps.
        Or the CEO’s friend (me), who is always being “pumped” for positive information about certain doctors and hospital personnel.
        I always tease her: “I am NOT YOUR spy.
        All the doctors were really good.”

        I would never tell a doctor who my friend is.

        The other day she asked me to write her CEO husband a letter, telling him about my positive experiences.

        I said “sure,” but haven’t yet.
        Apparently, not many write to the CEO with a positive experience. I guess I could find some nice things to say.
        In our area (Southern California), there are an abundance of physicians.

        For now.

    • buzzkillerjsmith

      Doesn’t sound as if you’re a doc. Every day we see folks who aren’t treating us well–difficult pts. If we fought with them all we’d be fighting every day. Best to move on.

      Many times these are the same folks giving the checker a hard time at Safeway and getting into scrapes with other parents at the soccer games or talking loudly in the restaurant about how the chicken is not the best they’ve had.

      • Cyndee Malowitz

        buzzkillerjsmith – I’m a NP, but you already knew that. I own my clinic and I’ve certainly encountered patients like this. Like I said, if they don’t like the service, they can go elsewhere. You don’t have to fight with them, just send them a letter and give them 30-45 days to find another provider.

        I know physicians who won’t put up with this type of behavior and they fire disgruntled patients quite often. It can take up to 4 months to get in to see my personal physician Medical providers (physicians and NPs) don’t exactly grow on trees – there is a shortage of ALL of us.
        You guys must live in an area with an abundance of providers. It’s not like that where we live.

        • buzzkillerjsmith

          No disrespect Cyndee, but I did not know that. I know it now and will not forget it.

          There is a huge doctor shortage here in southeast Washington state. My county is larger than Delaware and has 40,000 people. Docs (and their wives) don’t want to move here. My doctor is a very smart and very personable nurse practitioner.

          I have been a post-residency doc for 24 years come July and have fired about 5 pts.

        • disqus_XpaeflETHK

          A+ Cyndee. I think when these entitled unreasonable patients are constantly coddled by their PCPs they become more unreasonable. I lost the empathy a long time ago.

    • Suzi Q 38

      Your atitude is wrong and unrealistic for most physicians.

    • J.L. Creighton

      Treat enough patients poorly and you may eventually end up in the enviable position of not having any patients at all.

      Suzi Q is exactly right: “This cavalier approach to weeding out patients would not get you new ones. Word gets around.” It’s a fact in customer service that consumers will tell others about their customer service experiences, both good and bad, with the bad news reaching more ears. A recent survey showed that those who’ve had a bad experience tell on average 16 people about it – and social media is just amplifying that.

      Yes, if you are the only provider in town, you will still have patients who will have to come to you, whether they like it or not. A surly, arrogant over-entitled medical provider is better than none at all, of course. But do you really want your patients only there under duress, not because they think you’re a good nurse but because you’re all they can get?

  • betsynicoletti

    It is always difficult to listen to criticism or complaints: the natural tendency is to explain/rebut. I think the advice to listen and slow down the conversation is great, thanking the person for telling you. It doesn’t signal your agreement with what the patient is saying. Sometimes, being listened to alone diffuses the situation. Thanks, Susan.

  • buzzkillerjsmith

    Number 3 works very well. Leave the exam room, shake your head and smile to yourself and appreciate, if you can, the wonderful invention of human folly. I realize this takes some self-training.

  • disqus_XpaeflETHK

    This is great advice. When i see these patients are also gaming the system on their fake soc security disability, long term workers comp, also w “fibromyalgia” it makes me even angrier. I think providers should sometimes “counsel” these entitled that they are full of s….

    • Kay Dee

      Having fibromyalgia is gaming the system, or is that only when it’s in quotes? Are the folks with “fibromyalgia” who work 60 hours a week also gaming the system? I realize that there are still some “doctors” that don’t believe that fibromyalgia is a real thing – if we don’t know what it is or how to test for it, it can’t be real. Surely you possess all the wisdom of the world, and when you die, all wisdom will die with you.

    • Guest

      There are people with all kinds of diagnosis that “game the system”, this is not a “fibromyalgia” problem. I understand that you are not educated about this neurological disorder, therefore you think it doesn’t exist. How about you search any medical research database and you can educate yourself (so the rest of us don’t have to!) and then you can be capable of making reference to it.

  • Jay Rosenberg

    As I read this, I thought to myself that this is something Susan Keane Baker would say–imagine my smile when I saw that you WROTE it! Great article, great advice. Hi Susan–remember me from NJ? :-)

    • Susan Baker

      Jay – I certainly do remember you! I still have the photos of your Exit Pass board! Hope all is well with you and your family. Susan

  • Rob Burnside

    Everything I know about interacting with others I learned watching “Leave it to Beaver.” Was it Wally who said to Beaver, “Possession is nine points of the law…” or was that Eddie Haskell’s line? Maybe it was Eddie talking to Wally. On the cusp of old age, I really can’t recall, and it really does make a difference. As a health care provider, you can be Wally, Eddie, or The Beav. Might as well throw in Lumpy, too. Forget about Ward and June—too plastic! My point is: make the punishment fit the crime. Many “entitled” patients are in fact harmless, only looking for acknowledgement or reassurance (give them Wally). Others are clearly there to ruin your day (They get Eddie). If your’e uncertain, try Beaver. If you don’t want to be bothered playing mind games, Lumpy. “Life is but a stage…”

    • Rob Burnside

      Because I seem to have stifled further comment on this excellent article (not my intent), I’m going to take the unusual, and decidedly narcissistic step of replying to my own seemingly snarky remarks.

      First of all Rob, don’t you mean “All the world’s a stage…”? and second, don’t you realize most of Kevin’s bloggers grew up watching the Simpsons, not the Cleavers? You’re showing your age, Bub, and if you intended something like “Just be yourself, be human, be real, and above all be kind (because most patients are scared —-less)” why didn’t you say so?

      • Susan Baker

        Rob, I didn’t view your remarks as snarky. I love that you replied to your own post though :) . Thanks very much!
        Susan Keane Baker

        • Rob Burnside

          Really, thank YOU Susan. Medicine is awfully tough these days, and what you’re providing is so very good and necessary. And as far as replying to myself, you probably know the old saying, “Old age doesn’t come alone…” NDY (not demented yet), Rob

  • Chris Graham

    While I’m not trying to start a snarky discussion, I’m going to try to use some of these tecniques when dealing with entitled physicians.

    • J.L. Creighton

      Quite so.

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