The Ethics and Etiquette of Dealing with a Patient’s Bad Behavior

Aashi Arora 18 Apr 2025

As a physician, when you’ve been called in to care for a patient, your focus is on providing the care they need to diagnose and treat their medical issues. Therefore, it can be a shock when the patient or their family objects to your treatment approach or even to the presence of you or other team members based on factors that have nothing to do with the quality of care provided—such as ethnicity, age, or gender. Too often, when confronted with discriminatory or disrespectful patient behavior, doctors find themselves paralyzed, unable to respond effectively in the moment.

The need to remain professional in interactions with patients should not, and does not, mean having to tolerate objectionable behavior from patients or their families. However, nobody should feel ashamed for not having a ready response to unexpected incidents when their expertise or judgment is unfairly disparaged based on their identity or when they are otherwise treated disrespectfully. Like other clinical skills, being able to call out inappropriate patient behavior with professionalism and set clear boundaries are things that can be taught to ensure that physicians are not caught flat-footed by such incidents.

What Do Physicians Owe to Rude Patients?

In Opinion 1.2.2, the American Medical Association’s Code of Medical Ethics addresses the question of discrimination and disruptive behavior by patients by first noting, “The relationship between patients and physicians is based on trust and should serve to promote patients’ well-being while respecting the dignity and rights of both patients and physicians. Disrespectful, derogatory, or prejudiced language or conduct, or prejudiced requests for accommodation of personal preferences on the part of either patients or physicians can undermine trust and compromise the integrity of the patient-physician relationship.”

Thus, physicians are always expected to treat patients with compassion and respect, but they are called on to put the goals of patient care first before accommodating a patient’s request for an alternate physician. They are also encouraged to explore, when possible, potentially treatable clinical or personal reasons that might motivate patient behavior and address them. At no point, however, are they expected to compromise the safety of healthcare personnel in the face of threats, and if a patient refuses to discontinue derogatory or disrespectful behavior within their control, the physician can terminate the patient-physician relationship.

Those in leadership roles have an additional responsibility to monitor the messages their institution sends out and how it responds to instances of disruptive patient behavior. Clear expectations should be formally set on how such behavior will be addressed, data tracked to improve the handling of any incidents, and open support provided for physicians and other medical personnel who are affected. Leadership can also provide practical support by providing explicit coaching on what to do so that physicians are prepared rather than blindsided and demoralized if a patient treats them with disrespect.

Tips for Dealing with Bad Behavior from Patients

No doctor wants to think that their efforts to care for a patient will be met with disrespectful or discriminatory behavior, but it does happen. How do physicians and their institutions prepare to deal with bad patient behavior—and ideally shut it down before it can escalate?

• Have standard replies to hand: Craft quick, automatic responses that call out the behavior and set limits. Examples include “Let’s keep it professional” or “We don’t tolerate that kind of speech here.” Considering what to say in advance will help prevent hesitation and uncertainty.
• Be firm: Use plain language in the moment and avoid arguing or negotiating.
• Teach and practice these skills: It’s very common for physicians and medical students to be unsure of how to handle these types of incidents and to feel uncomfortable advocating for themselves. Providing explicit training and roleplay opportunities helps to build the skills necessary to effectively handle boundary issues and unacceptable comments.

If your institution is unsure of how to provide such training, or if you have been troubled with an increasing rate of problematic patient interactions that physicians have felt unequipped to handle, it can be helpful to bring in an outside coaching expert. This not only gives your staff confidence that they will know how to respond if an issue arises but also demonstrates your commitment to maintaining a safe and respectful workplace.

At iRISE Executive Coaching, we specialize in working with the healthcare sector, understanding the distinct challenges faced by medical professionals. We excel at empowering physicians through individual, group, and team coaching. Our focus is on strengthening leadership skills, building resilience, and preparing doctors to handle difficult situations with confidence and professionalism. To explore how we can support your staff, schedule a consultation by contacting us here.