My rogues' gallery of patients

Most patients are a pleasure to deal with, but some, as every doctor knows, are trouble. Such troublemakers can range from the merely annoying or disruptive-those stressed-out types, for instance, who want immediate results or who want us to bend the rules for them-to the downright dishonest and even dangerous. Here are some patient types we've seen-and strategies we've employed to handle them:

The Prying Parent. This type can be impossible to deal with, as illustrated by Meddling Mom, a member of an eccentric clan my staffers have nicknamed "The Royal Family." Besides Mom, there's Powder Keg Pop and their two adult children, whom they live with. Mom feels she has the right to know everything about everyone's medical maladies, despite the adult children's views to the contrary. Fortunately, there's HIPAA (none of the Royal heirs listed "Mom" as one of their authorized contacts), which gives us an excuse to say No to prying parents like Mom, and to do so legally. In such cases, I'm actually happy that otherwise pesky set of privacy rules exists!

The Hot Reactor. Powder Keg Pop presents a different kind of problem. Faced with a billing or referral hassle, he lets loose with an expletive-laced Royal tirade, directed over the phone or in person at one or another of my staff members.

My habit is to call incendiary patients myself, let them vent, and, if my staff has made an error, apologize. In some cases, I'll give patients a quick tutorial on their own managed care responsibilities. I'll also remind them that profane language directed at my employees is unacceptable-and that they need to watch what they say as we work to improve our service. When the doctor bawls them out for their behavior, patients usually become contrite. The only patients I've had to admonish more than once are members of The Royal Family, especially Powder Keg Pop.

Some explosive types go well over the line, however. Walk-in Wally, for instance, barged in on a busy Saturday when I was already 45 minutes behind schedule. Having problems with bronchitis, he demanded to be seen immediately, paced the waiting room and muttered obscenities when he wasn't. Trying to mollify him, my nurse came back to my office, explained the situation, and then called the police from my phone. Although he fled before they arrived, I was grateful to her for reacting so quickly, especially when the responding officer told us that Wally had a record of domestic violence and cocaine possession.

The Forger. Some patients are less scary, but a whole lot stealthier. On a recent Thursday, for example, the local school nurse inquired via fax about one of my high-school-aged-patients, whom I'll call Josh. Josh wanted to play basketball, it seemed, and I hadn't cleared him for sports on his physical form. Would I amend the faxed form?

I examined it and immediately suspected foul play: Although I'd seen a member of Josh's family on the date in question, I hadn't seen Josh himself. On closer inspection, the entire form appeared forged, including my signature and my nurse's.