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Dealing With Difficult Patients


Experts discuss their tips for dealing with difficult patients, including those who refuse to pay, badmouth colleagues, and even cause a scene in the waiting room.

Dealing with difficult patients—including those who don’t want to pay for service—takes a special skill set. Veteran dermatologists shared their top tips for dealing with difficult patients at the Fall Clinical Dermatology Conference for PAs & NPs, held November 12-14, in Orlando, Florida, and virtual.

David Pariser, MD, senior physician at Pariser Dermatology Specialists, Norfolk, Virginia; Roger Ceilley, MD, dermatologist, surgeon, and director of the training program at Mohs Surgery and Dermatologic Surgery in West Des Moines, Iowa; James Q Del Rosso, DO, Research Director of JDR Dermatology Research in Las Vegas, Nevada and Senior Vice President of Clinical Research and Strategic Development at Advanced Dermatology & Cosmetic Surgery in Maitland, Florida; and Mark Lebwohl, MD, dean of clinical therapeutics at the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai Icahn School of Medicine, New York, New York, shared their insight.

When patients are upset and complaining, the speakers advised staying calm, listening to their complaints, and standing your ground.

“You don’t have to show up for every fight you are invited to,” Del Rosso said. “You don’t have to let them draw their anger to you, but you still have to show your boundaries. Take a deep breath and try to reset yourself because it is easy to get caught up in it.”

If patients are arguing or making a scene with staff in the waiting room, “try to get out of the front office so everyone is not seeing and hearing [the scene],” Del Rosso added.

If there is yelling involved, it could be a patient trying to be made to leave the office so they do not have to pay, Del Rosso said.

Pariser gave the example of a patient who requested an “emergency work-in” to have a dermatologist examine potential melanoma. Then, after a quick examination by the doctor who explained that the issue was not melanoma, she refused to pay for the visit.

“You have to hold onto that it is a professional service, and there is a charge for the visit,” Del Rosso said. “Set boundaries. You can’t force people to respect you, but you can refuse to tolerate their disrespect.”

At the same time, if patients have a legitimate complaint, “there is a reason why you have 2 ears and 1 mouth. Listen to them,” he said.

When a patient comes in with a long list of issues to address—more than can be covered in a typical visit— Ceilley recommended to first take the list, “otherwise they will go on and on”. Then, let the patient know “we are not going to be able to address all these today. We will schedule another appointment to go over all of this,” Ceilley explained.

If a patient is on their way out of the office and says, “Oh, by the way, I have another issue to address,” Lebwohl suggested replying, “If I’m behind, I’ll say, ‘We don’t have time for that today,’ but if I have time, I say, ‘We will make you a chart and see you today.’”

When a patient bad-mouths another dermatologist, Lebwohl always tells the patient, “I know him. He is excellent.” It not only shuts down further discussion, he said, but patients appreciate the fact that you are not badmouthing the competition.

“Impatient” patients often need an explanation of how long a procedure will take and why. With acne, for example, tell patients they need to commit to 90 days of treatment, Ceilley said. “You have to explain the chronic nature of the disease,” he noted.

Some procedures, such as a large cyst, may take time to remove, Del Rosso said. He suggested telling patients, “We have to schedule that.” Del Rosso added to “be empathetic, but don’t put yourself behind an hour.”


Pariser, D, Ceilley, R, Del Rosso J, Lebwohl M. Dealing with the difficult patient. 2021 Fall Clinical Dermatology Conference for PAs & NPs. November 12-14, 2021. Orlando, FL and virtual.

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