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Most clinicians in orthotics and prosthetics can recall encounters that felt challenging. Sometimes staff warn us about a patient before we even enter the room. The label “difficult patient” is common in healthcare settings, yet it may not always reflect the full reality of the situation.
In many cases, the difficulty lies not in the patient alone, but in the interaction between patient and clinician.
When First Impressions Shape Expectations
One clinical encounter illustrates this point well. Before meeting a new patient, staff quietly warned that he could be difficult. The patient quickly expressed strong frustration about previous care he had received from a prosthetist who was no longer at the clinic.
Although documentation in the clinical record was limited, some of his complaints appeared justified. Much of his frustration, however, centred on how he believed he had been treated rather than on the technical aspects of his prosthetic device.
His dissatisfaction had persisted for months, and sharing this experience was clearly important to him.
At first, several aspects of his behaviour raised questions about credibility. Some complaints related to issues commonly seen during early prosthetic fitting, while others expanded into unrelated frustrations about politics and customer service.
Rather than dismissing these concerns or correcting his perceptions, the clinician chose to listen and acknowledge the patient’s frustration. Over time, that approach helped build trust and eventually allowed the discussion to shift toward solving current prosthetic problems.
The Problem with the “Difficult Patient” Label
Most practitioners can quickly recall patients who challenge their patience or communication skills. Research supports this common experience.
A study by Jackson and Kroenke involving 38 clinicians and 500 patients found that approximately 15 percent of clinical encounters were perceived as difficult. In a busy O&P practice, this could mean multiple difficult interactions every week.
However, labeling someone as a “difficult patient” can create problems of its own. It risks placing responsibility for the encounter entirely on the patient while overlooking the role clinicians play in shaping the interaction.
Psychiatrist R. Gregory Lande has suggested that focusing on the encounter itself, rather than the patient, helps shift attention toward the shared relationship between clinician and patient.
Every clinical interaction is influenced by both participants.
Recognising the Role of the Clinician
Many practitioners can recall situations where their own reactions escalated tension. Responding defensively, correcting patients too quickly, or attempting to “win” an argument often leads to greater frustration on both sides.
Research suggests that clinician communication skills can significantly influence how encounters unfold.
In one clinical trial involving primary care physicians, doctors who received training in communication and emotional-support techniques used more effective strategies when addressing patient concerns. Importantly, these improved interactions did not increase consultation time.
Patients treated by trained physicians also reported reduced emotional distress.
Another study found that physicians who completed a single-day communication workshop reported fewer patient encounters that they considered frustrating.
These findings highlight the powerful role clinician behaviour plays in shaping patient relationships.
Why Some Encounters Become Challenging
Patients seeking prosthetic or orthotic care often face complex personal circumstances. In addition to the condition that requires treatment, many individuals live with chronic disease, disability, financial stress or social challenges.
These pressures can influence behaviour during clinical visits.
Research has identified several characteristics that clinicians often associate with difficult encounters. These may include anxiety, unmet expectations, emotional distress or dissatisfaction with previous healthcare experiences.
Interestingly, studies have shown that difficulty in clinical encounters is not strongly associated with common medical diagnoses such as diabetes or cardiovascular disease. Instead, emotional and psychosocial factors appear to play a larger role.
Understanding Behaviour in Context
Psychiatrist James Groves famously described several behavioural patterns that clinicians may encounter when working with frustrated patients.
These include individuals who are:
- highly dependent on clinicians
- demanding or entitled
- resistant to help
- struggling with self-destructive behaviours
Such behaviours can provoke strong emotional responses in clinicians, including frustration, defensiveness or even resentment.
Recognising these reactions is an important step toward managing them professionally.
The Influence of Clinician Beliefs
Clinicians also bring their own beliefs and attitudes into patient encounters. Studies using the Physician Belief Scale have shown that healthcare providers who place less emphasis on psychosocial aspects of care report a higher number of difficult encounters.
While O&P practitioners do not diagnose psychological conditions, understanding emotional and social influences on patient behaviour is essential for effective care.
Issues such as non-adherence, unrealistic expectations or dissatisfaction with treatment are often linked to emotional factors rather than purely clinical ones.
Ignoring these influences can make patient management significantly more difficult.
Shifting the Focus from Conflict to Collaboration
Family physician John Launer has suggested that challenging behaviour often reflects deeper feelings of frustration, loss of control or previous negative experiences with authority figures.
From this perspective, the clinician’s response becomes central to resolving the situation.
By focusing on communication, empathy and collaborative problem-solving, practitioners can often redirect difficult interactions toward productive outcomes.
This approach does not mean ignoring inappropriate behaviour. Instead, it involves recognising that patient frustration often reflects underlying distress.
Lessons for Prosthetics and Orthotics Practice
For O&P clinicians, building trust is particularly important. Prosthetic and orthotic care requires repeated appointments, long-term relationships and significant patient participation.
When patients feel heard and respected, they are more likely to engage positively in treatment.
Even simple strategies—such as allowing patients to fully express concerns before redirecting the conversation—can dramatically change the tone of an encounter.
Reflecting on Our Role in Difficult Encounters
Most clinicians will encounter difficult situations at some point in their careers. What is remarkable is not that these interactions occur, but that the majority of patient encounters remain positive despite the significant challenges many patients face.
By reflecting on our own responses and communication strategies, we can often prevent small tensions from escalating into major conflicts.
Ultimately, focusing on the clinician-patient relationship rather than labeling individuals as “difficult” allows practitioners to approach challenging encounters with greater professionalism, empathy and effectiveness.
This perspective not only improves patient care but also reduces stress for clinicians, allowing them to devote more energy to what matters most—helping patients achieve better outcomes.
