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Trouble in The Treatment Room


The doctor patient relationship is most successful when both parties respect and trust one another.

Treat each patient consultation as if it is their first.

The treatment room is the place the doctor meets with their patient. This article aims to encourage thought and discussion about how best to avoid and cope with difficulties that may arise during the doctor’s work as they provide care for challenging patients.

Patients who experience serious mental health issues, and those who suffer substance addiction are among the most difficult to manage, and at times they can also pose a personal risk to the doctor. These patients may be desperately sad, angry, or manipulative.

The discussion that follows aims to help reduce the frequency and force of unpleasant exchanges between doctors and their more challenging patients.


To be treated by a doctor the patient is given a specified time to attend an appointment, and more often than not they are required to wait. Patients with a history of serious mental health issues, and those who are addicted to a substance are likely to feel more agitated than other patients. It is therefore advisable these patients are seen promptly at the arranged time as a preventative strategy.

It may be that a particular period in the day is devoted to fulfilling appointments with challenging patients as this will likely lesson their state of anxiety. It may also be helpful to set expectations about a time frame in which the patient will be seen, rather than specifying a particular time.


At times it will be necessary to clearly define the relationship between the doctor and patient by setting out exactly what the patient can expect in the course of their treatment with a clear written agreement. This can then be referenced if there are disagreements about how much, and when medication is prescribed in future.

It is possible those with chronic pain (physical or psychological), or substance addiction, may feel great anxiety about their current level of medicinal support, and an agreement will serve to evidence what has been previously established, and helps quell the strength of negative feeling they have towards a particular doctor.


The treatment room is a place of control. The patient enters a less familiar space, and greets the doctor, a figure of authority, who has access to information about them, who exams them, and who has the means to prescribe treatment. For their part, the patient has control of their intension, and it is this that may cause uncertainty and anxiety in the doctor’s mind.

Mental health patients and substance abusers are likely to feel greater vulnerability than a patient attending an appointment for a physiological problem. No matter how friendly the doctor’s demeanour, the patient is in a subordinate position. Furthermore, as the doctor talks in a calm and steady voice, this may contrast with the agitated inner state of the patient.

Control need not be a negative quality in the treatment room, indeed it serves to provide clear boundaries for both the doctor and patient, however acknowledging the different ways control is present allows the doctor to modify their behaviour and environment so that the patient feels more comfortable, and in turn, more agreeable. It may for example be helpful to place further emphasis and time on the initial greeting as the patient enters than one might usually devote to a less challenging patient.


If the patient is frustrated or angry because of a long wait, the doctor could begin the conversation by acknowledging the inconvenience caused, and discuss how this might be best avoided in future. The doctor might also explain how it would be advisable to arrange for an early appointment as this would reduce the likelihood of a long delay.

If a patient has a complex history of mental health issues or substance addiction, it will be helpful to collaborate with others in the practice prior to their appointment so everyone communicates a consistent message to the patient. This will place a break on the manipulative patient who asserts that another member of staff agreed a different course of action or medication.

If the patient is angry, they may feel they have not been attended to appropriately, or have an underlying fear or concern about their treatment. Sympathetic listening to their point of view will often dissipate their frustration as the doctor openly seeks options and solutions to their concerns.

When a patient is insulting or rude, the doctor should take a breath, recover, then respond calmly. The patient’s behaviour is usually as a result of pent up frustration and worry, rather than it being personal toward the doctor, even though it feels like it at the time.

A warning or termination of care by the practice is the final measure that can be made if a patient is abusive or violent.


The doctor patient relationship is most successful when both parties respect and trust one another. Part of the doctor’s work is to encourage these qualities through compassionate dialogue, and to guard against any negative attitudes they may have based on previous meetings. Treat each patient consultation as if it is their first.

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