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When a Patient is Too Crass, I Pass

Paul S. Koch, M.D.

The recent brouhaha in the stands at a professional basketball game brings to mind the tensions that exist not only between athletes and their fans, but also between doctors and their patients sometimes. Some fans think that just because they attend a game they have the right to abuse the players. "We paid to be here," they think, so we have the right to curse, throw beer, and pick fights.

How many times have we seen patients, who would be perfectly pleasant if we saw them on the street, turn into rude and abusive idiots once they walk through our door? "You're getting paid to examine me," they think, so in some perverse way they feel they can turn the office visit into a sporting event. I don't know about you, but I don't pay my staff enough to put up with me on my bad days, never mind putting up with abuse from strangers, too.

But patients are a complicated lot, and there's a fairly wide swath of gray between the sweet and the rude. Here's how I handle the tough patients in my office. The way I see it, patients on any given day fit into one of three groups. The first group is patients who are sick. No one ever said sick people had to be nice. They feel awful, and are exhausted physically and mentally. They're worn down, and being pleasant is fairly low on their list of things to do today. Sick people automatically get a pass.

The next group is patients who are nervous. They say something rude or nasty to you just as you are about to begin an operation. Have you ever wondered why on earth they would say something to irritate you just before you cut them with a knife? Let it go. These patients are terrified and want to say something to break the ice, or to show that they are cool under the circumstances. They can't think of something clever to say, so they spout off whatever comes to mind, however irritating. Nervous people get a pass, too.

Sometimes, Enough's Enough

The last group is patients who are caustic and rude from the moment they walk through the door. Make your own call on whether you want to see this group. When I was young and hungry I put up with all sorts of abuse, but now that I am established and comfortable, it is much easier for me to say, "You are clearly unhappy with my practice. I'll release you so you can find one more to your liking." Then I smile, thank them for coming, and apologize as I show them the door.