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  • Writer's pictureDavina Tiwari

A Mindset to Help You Cope with a Difficult Interaction with a Patient

Updated: Mar 5

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***Disclaimer: This article is for informational purposes only and does not provide medical, legal, or health advice and is not a substitute for mental health services

Having a challenging session with a patient is something that all healthcare professionals experience at some point in their careers. These moments can prove to be very upsetting for both parties and can be triggered by or occur for a vast number of reasons, some of which we may never fully know or understand.

While we can’t always prevent a difficult situation from happening, we can try to find ways to deal with it to soften the impact or hopefully reduce the chances of it happening again or at the same level of intensity.

Here are some possible useful ways to think about a difficult clinical interaction and how to respond.

Remove yourself from the situation when safe to do so, if necessary

Trying to resolve the issue at the time is often explored first, however, if the situation continues to escalate and you feel increasingly distressed and uncomfortable finishing the session, then remove yourself as soon as it is safe to do so. Explain that you will return another time (e.g. later that day or the next day, etc.) when you are both able to talk to each other calmly.

Understandably, the timing of being able to remove yourself may differ if you are in the middle of providing some form of personal or invasive care versus if you are having a conversation from a distance. Use your best judgment. Also ensure that you document the objective, factual information from the interaction based on your professional regulatory body guidelines and recommendations.

It’s important to note here that you do not have to take verbal, emotional, psychological, physical, or any other kind of abuse. You do not have to “push through” an unsettling situation just because of client or employer or professional expectations. You have rights as well.

By removing yourself from a heightened situation, you are keeping both of you safe from further escalation and clinical relationship breakdown. It also gives you space to regroup, calm yourself, and think through how you want to approach the situation.

Access your organization’s resources

In cases where you feel it is could be helpful, make use of your Employee and Family Assistance Program (EFAP) services for short term counseling if you are feeling distressed or significantly impacted emotionally by the interaction that occurred. In certain circumstances, it may make sense to file an incident report with your organization.

Speak with your manager if you are comfortable to explain the situation and to discuss your options.

Consider it as a difficult interaction — not a difficult patient

Notice the words “difficult interaction” rather than “difficult patient”. They both carry entirely different meanings, where one is about the situation and the other is about the person. Taking a step back and thinking about it as an external matter can help you gain more perspective, make it less personal, and allow you to think about your next move in a more objective way.

Know that it’s not necessarily about you as a person or clinician

Using this angle will help you be more proactive in your interpretation of the situation and assist you in figuring out how you want to proceed.

A patient’s response to you may be more about their previous experiences, hardships, and challenges than about you as an individual. You may remind them of someone from their past, or the situation you are working with them through or the environment you are helping them in could bring up adverse memories that they associate with you based on your profession or your status in your workplace.

Try your best to understand where they could be coming from and realize their reactions could be beyond you and more about the circumstances surrounding you.

Create a plan for next steps

Once you’ve had a chance to settle, start thinking about how you want to handle things moving forward.

What else do you have to accomplish with this patient over the short and long term? Plan out the goals you need to address in future sessions and a timeline for when and how these goals can be attained.

Is there a trusted colleague who could participate in the patient sessions with you or that you can consult with separately to develop a clear plan? Draw on support from a valued coworker if needed and if possible. Work together toward the mutual clinical goals with your shared patient.

Find common ground with your patient

Think over what could be realistic goals or objectives that you and your patient could work together on. This may help you come together in a way that leads to a productive solution. It allows you both to think beyond the challenges in your working relationship and it also redirects your attention to something achievable within your scope of practice and expertise.

Perhaps you will be able to help them work on their mobility, personal care, independent living, health, or mental health priorities. Try to make these objectives — rather than the problems — the focus of your work together.

Ask the patient for feedback

Once you’ve both had space and time to reflect, and if you are comfortable, feel free to ask your patient for feedback about the interaction that occurred and if there is anything you can do to help improve the therapeutic relationship moving forward.

As healthcare professionals, we strive to find ways to build our strengths, consider areas for improvement, and continue finding ways to grow and develop in our careers. Understanding how to improve our clinical and therapeutic relationships are part of that journey.

Discuss a clinician transfer or referral to another healthcare professional if you remain at an impasse

If you find that your attempts to ease the strained connection, work on mutual goals, and resolve the overall issues are not accepted by the patient and you keep having similar interactions, then it is important to recognize when you need to set boundaries to protect your well being.

This may be seen as a last resort, however, it may make sense to explore whether another healthcare professional could be a better fit in working with this patient. You may need to consider referring your patient to another clinician or offer the patient suggestions for professionals with similar qualifications who serve the patient’s local region. Talk about this in your final session with your patient and answer their questions as best as you can.

Transferring a patient to another care provider doesn’t mean that you have failed or that you are an unsuccessful clinician; it means that you are considering what could be in both of your best interests.

Wishing you well on your mental health journey.

Davina Tiwari MSW, RSW, CSFT

Registered Social Worker and Certified Solution Focused Therapist

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