Toxic Mindsets in Outpatient Medicine: „This is a difficult patient.“

Data, facts and instruments on the German health system

What it’s about

„Oh no, there’s Mr S. That’s a really difficult person.“ These and similar thoughts run through the minds of many medical assistants in their everyday work. The label is given when practice visitors do not abide by rules, cross boundaries or break procedures, when they are annoying and provocative, aggressive and unsympathetic or when they complain.

Problem delimitation

However, in order not to prematurely assign a rating, which then usually sticks to the person forever, one should first clarify whether it is really a question of problem patients, or whether

  • this classification has perhaps only crept in because a colleague or practice partner has complained at some time about difficulties in dealing with them,
  • a visitor to the practice is simply unpleasant; often it is a matter of characteristics, behaviour and ideas that you yourself find strange, disturbing or unpleasant, e.g. because they are asked very intensively,
  • or because one’s own behaviour may have provoked corresponding reactions,
  • perhaps the problem the patient is talking about is „annoying“ because it cannot be solved and one is transferring one’s own frustration to the other person or whether
  • the work pressure is so high that delays caused by patients have serious consequences.


Experience shows that clarifying this question helps to significantly reduce the number of „difficult“ patients. However, the remaining residual group is not objectively defined either. Phlegmatic patients, cholerics, frequent talkers or similar persons may show more conspicuous or deviant behaviour than other practice visitors, but their classification is always subjective and above all caused by the fact that one does not have a suitable counter-strategy.

The real problem is therefore not so much these fellow human beings, but one’s own inability to deal with them in a communicatively correct way.

Example „Dominance

A difficult discussion situation arises, for example, when patients treat medical assistants from above, dominate them, and in extreme situations even try to belittle them. Sometimes an ironically accentuated formulation such as „Oh, yeah?“ or a patronising gesture from above is sufficient. The aim of this behaviour, regardless of the individual motive, is humiliation in order to make one’s own position seem more important. Employees who allow themselves to be intimidated by this lose their usual sovereignty and are forced into a passive role, often even collapsing in body language. As a consequence, and this is the crucial point, they lose control of the conversation. The solution to this situation is first and foremost to regain one’s inner strength through

  • an upright, stable outer posture,
  • at the same time you look at your conversation partner,
  • smiles and continues the conversation as if the attempt at dominance had never happened.

In most cases, the counterpart immediately recognises the ineffectiveness of his behaviour and allows himself to be led back into a normal, constructive conversation without losing face.