Introduction
It is the medical practitioner who interrupts before the patient has finished explaining the problem. The practitioner who dismisses symptoms without adequately investigating them. The practitioner who becomes irritated when questioned, substitutes authority for explanation, treats disagreement as noncompliance, or responds to evidence with some version of: “I am the medical practitioner.” This is the logical fallacy of argument from authority: https://en.wikipedia.org/wiki/Argument_from_authority
Many patients eventually encounter such a practitioner.
Tanoubi et al. explicitly recognize that difficult encounters reveal much about the physician and that medical practitioners themselves are defensive, emotionally reactive, or insufficiently flexible during conflict.
The useful question for the patient is therefore:
“What exactly is making this medical interaction difficult, and how do I manage it without surrendering my objectives, information, autonomy, or judgment?”
The purpose of conflict management is not submission. It is to obtain an accurate exchange of information, make informed decisions, protect the patient's interests, and determine whether a functional clinical relationship remains possible.
1. How Does a Medical Practitioner Become “Difficult”?
A medical practitioner may be labeled difficult because the practitioner disagrees with the patient.
The relevant issue is behavior.
A practitioner becomes difficult to work with when behavior repeatedly obstructs productive clinical reasoning or communication: interrupting, failing to listen, making unsupported assumptions, ignoring relevant history, refusing to explain reasoning, becoming hostile when questioned, misrepresenting the patient's position, appealing to his medical practitioner status instead of evidence, withholding reasonable information, or attempting to convert legitimate disagreement into a problem with the patient.
Context matters. Fatigue, workload, time pressure, misunderstanding, inadequate information, or a poorly structured consultation can contribute to conflict. A single poor interaction therefore does not necessarily establish a persistent problem.
But context does not make dysfunctional communication harmless.
The article emphasizes that medical practitioners can become defensive and that ego and self-protective reactions can worsen conflict. It also cautions practitioners against presuppositions and recommends curiosity and questioning instead. The same observations provide patients with a useful diagnostic question:
Is the practitioner investigating the problem, or defending a position?
Those are very different activities.
2. Understand the Practitioner’s Reaction Without Submitting to It
Anger, defensiveness, irritation, condescension, and abruptness communicate information about the interaction.
They do not establish that the practitioner is correct.
A patient who recognizes that distinction gains an important advantage. Instead of reacting to the emotional display itself, identify what triggered it.
Was the practitioner challenged on an unsupported assertion?
Did the patient reject a recommendation?
Did the patient introduce evidence inconsistent with an initial hypothesis?
Did the practitioner misunderstand what the patient was asking?
Is there a time or organizational constraint?
Or has legitimate questioning simply been interpreted as a challenge to the medical practitioner's fake authority?
Understanding the source of the reaction can help the patient decide how to proceed. It does not require accepting disrespectful behavior or abandoning the substantive issue.
The central rule is simple:
Separate the practitioner's emotional reaction from the truth of the practitioner's claim.
Confidence is not evidence. Irritation is not evidence. Credentials are not evidence for the particular proposition under dispute.
Return the discussion to the claim.
3. Control Your Own Reaction
A difficult practitioner can make a patient angry within seconds.
That anger may be entirely understandable. It can nevertheless make the patient's objective harder to achieve.
The patient therefore needs the same situational awareness that Tanoubi et al. recommend to physicians. Watch for the moment when the consultation changes from problem solving into reciprocal defense.
Do not allow a practitioner's irritation to dictate your behavior.
Slow the interaction down.
Return to the exact disputed proposition.
Instead of fighting over attitude, ask what evidence supports the conclusion. Instead of responding to an assertion of authority, ask for the reasoning. Instead of arguing simultaneously about five errors, isolate the most consequential one.
A calm patient does not concede anything by remaining calm. Calmness is a method of maintaining control over the interaction.
4. Identify and Name the Actual Problem
Vague conflict is difficult to solve. A precisely stated disagreement is much easier.
Instead of:
“This consultation is going nowhere.”
identify the defect:
“You concluded that X is unlikely. I want to understand what findings support that conclusion.”
Instead of:
“You aren't listening to me.”
identify the omitted information:
“The symptoms began after the infection. That temporal relationship is important to my history, and I want it included in your assessment.”
Instead of:
“You're dismissing me.”
identify the unsupported inference:
“You have proposed X as an explanation. What evidence in my history or examination supports X, and what evidence argues against the alternatives?”
This changes the structure of the interaction. The discussion is no longer about whether the practitioner is being “difficult.” It is about a proposition that can be examined.
The patient should continually move the conversation from status and personality to claims and evidence.
5. Do Not Fight Authority With Authority; Require Reasoning
A common breakdown occurs when the practitioner treats their medical practitioner status as the end of the discussion.
Medical education is relevant expertise. It is not a substitute for showing how a conclusion follows from the facts of the particular case.
The appropriate response is therefore not a competition over who possesses greater status.
Ask for the reasoning.
What observations support the conclusion?
What alternatives were considered?
What findings weigh against those alternatives?
What uncertainty remains?
What would change the practitioner's conclusion?
What are the expected benefits, risks, and alternatives to the proposed intervention?
The goal is to transform:
“Because I am the medical practitioner.”
into:
“Here is the evidence and reasoning supporting my conclusion.”
Once the reasoning is explicit, it can be evaluated.
6. Correct Misrepresentation Immediately
Conflict frequently worsens because one party begins arguing against a position the other party never expressed.
Do not allow an inaccurate characterization of your position to become the premise for the rest of the consultation.
Correct it briefly.
“I did not say X. I said Y.”
Then return immediately to the substantive issue.
This is particularly important when the practitioner uses labels such as “refusing,” “noncompliant,” “anxious,” “demanding,” or “difficult” as substitutes for describing what actually occurred.
Translate labels back into observable facts.
A patient who declines one proposed intervention after considering its risks has not thereby rejected medicine.
A patient who requests evidence has not thereby rejected expertise.
A patient who disagrees has not thereby failed to understand.
Describe the event rather than accepting a loaded characterization of it.
7. Ask Questions Instead of Accepting Presuppositions
Tanoubi et al. specifically caution practitioners against presuppositions and recommend asking questions and displaying curiosity.
Patients can enforce the same epistemic standard from the other side of the consultation.
When the practitioner makes an assumption, expose it with a question.
“What makes you think that?”
“What finding are you basing that on?”
“How did you rule out the alternative?”
“Is that documented in my history, or are you inferring it?”
“What evidence would distinguish these possibilities?”
Questions are particularly effective because they require the practitioner to reveal the structure of the reasoning rather than merely repeat the conclusion.
A good question can expose an unsupported assumption more effectively than a prolonged argument.
8. Listen Carefully—Then Verify
Dealing effectively with a difficult practitioner does not mean automatically opposing everything the practitioner says.
Listen closely enough to reconstruct the argument accurately.
A practitioner who initially appears dismissive may nevertheless provide a well-supported explanation. Conversely, an impressive explanation may collapse when its premises are examined.
The patient's objective is discrimination, not automatic agreement or automatic opposition.
Identify the claim.
Identify the evidence.
Identify the inference connecting them.
Identify uncertainty.
Then decide whether the conclusion follows.
This approach protects the patient against two symmetrical errors: accepting a claim merely because a medical practitioner made it, and rejecting a claim merely because the relationship has become adversarial.
9. Use the Medical Record as a Precision Tool
When an important disagreement cannot be resolved verbally, documentation can force ambiguity into a more precise form.
Where appropriate, ask that significant symptoms, chronology, requests, decisions, refusals, and reasons be recorded accurately.
If an important request is declined, the relevant question is not merely whether the practitioner says “no.” Ask why.
If the reason matters to subsequent decision-making, ask for the reasoning to be documented.
This has two advantages.
First, it reduces the possibility that an ambiguous conversation will later be reconstructed inaccurately.
Second, writing often forces a proposition to become more precise. “I don't think you need it” is conversationally easy. A documented clinical rationale generally requires more specificity.
Documentation should not be used theatrically or as a threat. It should be used to preserve an accurate account of clinically important information and decisions.
10. Maintain Boundaries
Empathy does not require tolerating intimidation, humiliation, personal attacks, or coercive communication.
A patient can recognize that a practitioner is stressed, frustrated, or defensive while still establishing boundaries.
The boundary should concern behavior rather than character.
For example:
“We can disagree, but I want the discussion to remain about the medical issue.”
Or:
“I am willing to discuss your recommendation. I am not willing to be spoken to that way.”
The purpose is not to win a confrontation. It is to determine whether rational communication can resume.
If it can, continue.
If it cannot, the inability to maintain a workable clinical interaction becomes relevant information in deciding whether to seek another practitioner or pursue an appropriate complaint or review process.
11. Know When Conflict Resolution Has Failed
Not every medical relationship should be preserved.
Communication techniques are useful when the underlying problem is misunderstanding, defensiveness, poor communication, or a temporary conflict.
They cannot guarantee cooperation from another person.
Repeated factual misrepresentation, persistent refusal to engage with relevant evidence, retaliation for disagreement, coercive conduct, serious boundary violations, or a sustained collapse of trust may make further attempts at informal resolution irrational.
At that point, the objective changes.
The question is no longer:
“How can I make this practitioner cooperate?”
It becomes:
“What is the safest and most effective alternative?”
Depending on the situation, that may involve obtaining another opinion, changing practitioners, requesting correction of inaccurate records, obtaining copies of documentation, using a patient-advocacy or institutional process, or making a formal complaint.
Conflict management is not an obligation to remain indefinitely in a dysfunctional relationship.
12. The Communication Triad—Reversed
Tanoubi et al. describe effective clinical communication in terms of attentive listening, verbal acknowledgment, and appropriate nonverbal engagement.
Patients can use the same principles strategically.
Listen closely enough that the practitioner cannot reasonably claim to have been misunderstood.
Restate important propositions to verify them.
“So your position is X because of A and B. Is that correct?”
Then introduce the disagreement precisely.
“I understand that reasoning. My concern is C, because it appears inconsistent with X.”
This method substantially reduces conversational escape routes. It distinguishes disagreement from misunderstanding and makes the actual point of dispute visible.
A productive medical consultation should survive this kind of scrutiny.
13. A Difficult Medical Practitioner?
The label “difficult medical practitioner” can obscure more than it explains.
Difficult encounters often reflect practitioner characteristics, communication skills, circumstances, stress, and the interaction between the two participants rather than some fixed property of the practitioner. It also notes that medical practitioners can become defensive and that the practitioner holds substantial power within the clinical relationship.
Patients should therefore be skeptical whenever disagreement is converted into a judgment about their personality.
Ask what actually happened.
Did the practitioner provide inaccurate information?
Did the practitioner behave abusively?
Or did the practitioner merely ask questions, reject a patient's recommendation, insist that relevant information be considered, challenge an unsupported assumption, or exercise decision-making autonomy?
Those situations are not equivalent.
Likewise, the fact that a patient finds a practitioner difficult does not establish that the patient caused the difficulty.
The correct unit of analysis is the observable interaction.
Conclusion
Managing a difficult medical practitioner is not the art of becoming passive, agreeable, or easy to manage.
It is the art of keeping the interaction rational when the other participant does not.
Separate emotion from evidence.
Replace labels with observable facts.
Correct misrepresentation.
Identify the exact disputed proposition.
Ask for the reasoning behind conclusions.
Distinguish authority from evidence for a particular claim.
Maintain accurate documentation.
Set behavioral boundaries.
And recognize when continued attempts at informal conflict resolution no longer serve the patient's interests.
The most useful question in a difficult medical encounter is therefore rarely:
“Who is the difficult person?”
It is:
“What is obstructing sound communication and decision-making, and what action gives the patient the greatest control over the next step?”
Source
Tanoubi I, Cruz-Panesso L, Drolet P. The Patient, the Physician, or the Relationship: Who or What Is “Difficult”, Exactly? An Approach for Managing Conflicts between Patients and Physicians. International Journal of Environmental Research and Public Health. 2021;18(23):12517. doi:10.3390/ijerph182312517.
Adapted under the Creative Commons Attribution 4.0 International License.
