Every physician in private practice eventually encounters the patient who tests every ounce of patience they have. Maybe it’s the one who arrives late to every appointment and expects to be seen immediately. Maybe it’s the one who challenges every medical recommendation with something they found online. Maybe it’s the one who is never satisfied, no matter how much time you spend or how carefully you listen. Challenging patient encounters come in many forms, but they all share one thing in common: they push us to decide what kind of clinicians we want to be when it’s hardest to show up as our best selves.
It’s tempting to label these moments as irritations, to grit our teeth and push through, or worse, to carry the frustration into the rest of the day. But if private practice has taught anything, it’s that these are also the moments that define us. Anyone can be compassionate when the patient is grateful, cooperative, and kind. Grace is revealed in the exam room when tension fills the air.
As for some of the reasons this happens, my colleague and SoMeDocs network member Dr. Brittany Panico, a rheumatologist, recently wrote an article for Doximity in which she offered up some of her own insight. “When [patients] feel misunderstood or alone in their journey,” she wrote, “Their anxiety escalates, making it harder for them to absorb information and trust their physician.”
There are, of course, so many reasons, for patients to be perceived as “challenging”. Academic family physician and SoMeDocs network member Dr. Santina Wheat, says, “Many of patients who are ‘difficult’ have had bad experiences with healthcare.”
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Regardless of the reasons for patients to be the way they are, we must deal with things on our ends, and professionally at that.
Research in the Journal of General Internal Medicine has shown that physicians’ empathy levels directly influence patient adherence and satisfaction, even in interactions where conflict or mistrust exists. In other words, how we show up in those tough encounters may determine whether the patient follows through with care, or walks away disillusioned. This isn’t to say we need to excuse bad behavior or tolerate abuse. Boundaries are essential. But approaching challenging patient encounters with steadiness and humanity can transform what might otherwise be a losing battle into something meaningful.
Research in the Journal of General Internal Medicine has shown that physicians’ empathy levels directly influence patient adherence and satisfaction, even in interactions where conflict or mistrust exists. In other words, how we show up in those tough encounters may determine whether the patient follows through with care, or walks away disillusioned. This isn’t to say we need to excuse bad behavior or tolerate abuse. Boundaries are essential. But approaching difficult patients with steadiness and humanity can transform what might otherwise be a losing battle into something meaningful.
Dr. Tea Nguyen, a podiatrist and SoMeDocs network member, weighted in with how she approaches the topic. “I stopped labeling patients as difficult and think about what are they really struggling with that they can’t yet articulate,” she said. “When they are humanized, I can sympathize.”
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The truth is, challenging patient encounters usually aren’t being made that way for the sake of it. The late arrival may be overwhelmed juggling family responsibilities or battling anxiety. The contrarian may have spent years feeling dismissed in the medical system. The chronically dissatisfied patient may be carrying pain or fear that has little to do with you, but shows up in the space between you anyway. Seeing beyond the surface doesn’t solve everything, but it helps reframe the situation: instead of “this patient is impossible,” it becomes “this patient is struggling, and I can choose how I respond.”
That choice matters. Responding with defensiveness escalates. Responding with cold detachment erodes trust. But responding with grace (with steady voice, open posture, and genuine listening.. and btw, or possibly organizing a public speaking online conference, which will touch on many communication factors involved in patient care today) shifts the entire dynamic. Grace doesn’t mean letting someone walk all over you. It means maintaining professionalism and compassion without losing yourself in the frustration. It means preserving dignity for both parties. And in private practice, where your name is on the door, it also means modeling for your staff how to handle hard moments with calm and care.
Some wins are invisible but profound. The patient who storms in angry but leaves calmer because you didn’t meet their fire with fire. The one who softens after realizing you truly listened. The one who, after months of resistance, finally trusts enough to follow through with your advice. These aren’t the stories that make headlines or fill conference podiums, but they’re the daily victories that keep practices alive and relationships mended.
There’s also self-preservation in grace. Stress hormones spike when confrontations escalate. Carrying that stress into the next encounter makes it harder to be present for patients who had nothing to do with the one before. Grace, then, is not only for the patient but for yourself. It creates a pause, a mental exhale, a moment to reset. Sometimes that means stepping out of the room after a difficult exchange, taking a breath, and reminding yourself that one encounter does not define your entire day… or your entire career.
In the end, challenging patient encounters aren’t just obstacles; they’re teaching moments. They reveal the limits of our patience, the edges of our compassion, and the strength of our boundaries. They remind us that being a physician in private practice is not only about medicine, it’s about humanity. And while we cannot control who walks through our doors, we can control how we meet them. With grace, we choose to bring light into spaces that could otherwise stay clouded with frustration.
It may not always feel rewarding in the moment, but over time, those choices add up. They create a culture in your practice that patients notice and staff absorb. They preserve your sense of professionalism and integrity. And, just maybe, they turn some of those “challenging” patients into the ones who surprise you with gratitude years down the line.
Grace is not weakness. Grace is strength. It is a choice to rise above what’s easy and to practice medicine in a way that honors both the patient and the practitioner. And in private practice, where relationships are the cornerstone of success, it may be one of the most powerful tools we have.
If this resonates with you, you’ll want to join our upcoming Private Practice Online Conference, where conversations like this one continue. Registration is still free for the first 100 people who sign up, so secure your spot today and be part of the community shaping the future of private practice.
In private practice, where your name is on the door, it also means modeling for your staff how to handle hard moments with calm and care.
