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How to Deal with Abusive Patients as a New Grad PT

by Justin Johnson, PT, DPT, OCS

"Some things cannot be taught; they must be experienced. You never learn the most valuable lessons in life until you go through your own journey.” -Roy T. Bennett

Let’s not beat around the bush: some people are rude and abusive. You will run into patients who are mean, plain and simple. Whatever problems they have going on are unleashed on you. Here are a few strategies I use to deal with abusive patients and do my best to stay cool.

1. Set boundaries

Tell someone if you find their behavior offensive. If they are doing something on purpose, give them one chance to explain themselves. If they continue to disrupt the session. You have a right to be respected. Leave if you need to.

Constantly working with others and dealing with difficult patients can be doubly tiring for introvert PTs. Here are a few tips you can use to re-energize and get back in the zone.

2. Listen to your body

Your mind may send you into a fight or flight mode when dealing with tough patients. Mine usually leans toward “fight,” and I feel like jumping over the bed and getting into it (I haven’t yet)! Simply leave the room. If your fight response is on, that should be a red flag. Always remember that most of the time you can walk out if the situation.

Do you only have thirty minutes to work with the patient? Make sure you chart how difficult they’re being. I’ve quoted patients in their chart so that the subjective end assessment accurately reflects their attitudes and how difficult they're being.

3. Reappraise the situation

Reappraisal is a strategy in which you change your interpretation of the event. When you start to get angry, reappraise the situation in your head, and reinterpret it as a training situation. I like to change my interpretations from “Gosh, I have to deal with this a-hole,” into “I get to train my nervous system to remain calm and control my emotions.” Dealing with difficult patients in this way will have benefits beyond your professional life. You can use this method in less professional settings like driving in your car or waiting behind slow people at a checkout counter. For more on reappraisal and other mind strategies for dealing with life I suggest the book Your Brain at Work by David Rock.

Reappraisal can feel nearly impossible when you're burnt out. It can get to the best of us, but check out our tips for avoiding burnout and staying at the top of your game.

4. Let ‘em have it

Yup, that’s right. If someone is really out of line and you can tell them, without physical violence or insulting them too badly, let them have it! Did your patient call you a name and insult you? Call them on it!

““You are being an absolute jerk! You insult me and expect me to help you? What planet do you live on? Not my planet! You are on your own. Your chart will reflect that you are insulting me and not worth my time!””

This, of course, is in a strong, stern voice. I walked out of the patient’s room. Not twenty minutes later he wheeled down to my office and apologized. I had a similar experience in home care with a patient’s daughter who was an absolute control freak, and I had to walk out. My patient was even embarrassed by his daughter's actions.

So where does this leave us? You are not alone in dealing with abusive patients. They exist everywhere and will be a part of every job. I have worked in places that seemed to attract them, but that’s a story for another day. Remember: you have the right to set boundaries, walk out when needed, and make note of how your patients behaved in their chart.

I personally find that having the mental tools to reappraise the situation is the most helpful, but your final (and usually most dramatic) way of dealing with abusive patients is letting them have a piece of your mind! Some may not agree with me here, but oh well. Let me know your questions and comments below. Thanks for reading!


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