Dealing with challenging patients can be difficult and stressful for doctors and health care professionals.

It can be helpful to remember that they can be difficult for a variety of reasons, such as pain, fear, confusion, or unmet expectations that were expressed or not — reasonable or not. To effectively handle challenging patients, a few key points must be kept in mind.

Remain calm and professional. This will help keep the situation from escalating and set an excellent example for your patient.

Listen to the patient and let them know you are trying to get their perspective. This will help identify the underlying cause of their behavior and may provide clues for how to address it.

It is important to communicate clearly and directly with the patient to ensure they understand what is happening and why. Empathy with clarity will help restore trust and rapport.

Involve the patient in the decision-making process and provide them with choices whenever possible, as this will empower the patient and may help improve their behavior.

And often, setting boundaries can become important.

It is essential to providing effective health care, as boundaries help establish clear expectations and can help prevent conflicts or misunderstandings. When setting boundaries with patients, there are a few things to keep in mind.

Be clear and direct with the limits you are setting. This will help the patient understand the boundaries and expectations you have of them.

Consider the patient’s perspective and see if a compromise is possible, but not at the expense of safety. When you compromise on your values and principles, there is always a price to pay.

Be consistent. If you allow a patient to cross a boundary once, you are actually inviting them to do it again, which can lead to conflicts and difficulties in providing care.

Be professional, firm, and assertive. It is OK to say no to a patient if their expectations, requests, or behaviors remain unacceptable or go against your professional judgment.

If a patient becomes abusive, it can become necessary to terminate the patient-doctor relationship.

This should be done in a respectful and professional manner while also preserving the safety and well-being of the professionals and of their staff as well.

Before you terminate the relationship with a patient, it is important to document the reasons why you feel the need to end the relationship. Document the behaviors and the failed attempts to correct or address the issues. This step will prove useful in the event that the patient files a complaint or legal action against the health care provider.

Inform the patient of your decision to terminate the relationship and provide information on obtaining care from another physician or provider as needed.

Don’t forget that it is also important to take care of your own well-being after terminating an abusive patient relationship by seeking support from colleagues, accessing assistance programs, or seeking outside counseling if needed. Of course, make sure to preserve patient confidentiality when doing so.

Jean Paul Brutus is a hand surgeon.