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Dealing with Difficult People

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One of the most impressive talks that literally changed my way of thinking and interacting with others was from Lloyd D. Newell, a motivational speaker, on the subject of dealing with grumps, grouches and difficult people.

In this article, I would like to share what I have learned about conflict management from a variety of sources in 24 years of ophthalmology.

Fact: Patients don’t always know if they received proper treatment, but they do know if they were treated well.

Staff has a great impact on patient care. Most patients interact with a staff member and develop an opinion regarding the physician and the practice before even seeing the office or meeting the physician.

As sensitive staff, it is helpful to recognize personality types in order to better interact with our patients. This certainly leads to improved communication on both the business and medical sides of ophthalmology. And it helps prevent and resolve conflicts that can naturally occur when interacting with the public, since we all tend to look at the world from a different set of glasses.

Why do we feel conflict is negative? Too often we equate it with friction, wasted time, bruised feelings and embarrassment. And it can undermine morale in the office.

However, there is need for both disagreement and synergy to foster growth. A diversity of opinions is a healthy condition that often prevents stagnation and stimulates new ideas, techniques, etc. It can increase productivity, enhance learning and motivate people to act.

There is not much we can do to change the aggressive behavior of others, but we can stop them from “chewing us up and spitting us out” and we can control our own reactions. Doing nothing when faced with disagreeable behavior only reinforces it. Our silence will ensure that it will continue. We can choose our response — we can act instead of react.

Difficult Personality Type

Best Way to Interact


  • Aggressive, rude and intimidating
  • Generally loud speaking
  • Never meet them head-on with the same type of behavior.
  • Allow them to speak for a while to “blow off steam.”
  • Walk or move closer to them, calling them by name.
  • Never lose eye contact.
  • Present your ideas in a friendly manner.
  • Speak softly.


  • Polite at first, but then will strike suddenly
  • Passive aggressive behavior
  • Ask a lot of open-ended questions and allow them to speak.
  • Provide data that can’t be refuted.


  • Make continual snide comments
  • Tattle-tales
  • Are considered back-stabbers
  • Confront them. Do not ignore a dig.
  • Ask them, “Do you mean that seriously or were you joking?”


  • Overbearing, opinionated
  • Only their ideas count
  • Be certain your facts are correct.
  • Put communication in writing.
  • Don’t allow them to continue to talk on and on.
  • Address each issue independently.

One principle that has contributed greatly to the productive handling of disagreements is: “Seek first to understand, then to be understood.” This principle was introduced by Steven Covey in Seven Habits of Highly Effective People and essentially means that, if we encourage others to explain their side first, they will be more apt to listen to ours.

When you interact with difficult patients, remember the following:

  1. Communicate in private. Do you have a room where discussion can take place away from other patients?
  2. Treat the other person with respect. Preserve their dignity and your own.
  3. Keep the focus on issues — not personalities.
  4. Assume the other person is expressing a legitimate concern.
  5. Listen with empathy. Try to put yourself in their shoes.
  6. Listen with neutrality. Listen to fully understand before your respond.
  7. Convey that you are interested in the person’s ideas, even if you don’t agree with them.
  8. State your own views using an “I” message instead of a “you” message. This may take the person off the defensive: “I’m concerned about the comments made.”
  9. Try to reach a compromise if possible.
  10. Reinforce positive behavior. Say thank you and mean it.
  11. Remember you do not ever want to get angry and lose control or say things that you don’t mean.
  12. When the confrontation is resolved, note that laughter is said to be internal jogging. It allows us to let off steam.

Hopefully by applying these strategies, you will increase your value to the practice while reducing your personal stress.

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About the author: Reprinted from a previous AAOE Techniques bulletin written by Sue Vicchrilli, COT, Coding Executive for the American Academy of Ophthalmic Executives.