Dealing with Difficult Patients

By Julie Scott / 19 Aug 2022

Nurse prescriber Julie Scott provides her tips for managing challenging patients

Every aesthetic practitioner I’ve ever spoken to has difficult days. Days when they want to quit the industry and never administer another treatment again, when they feel patient after patient is asking for a discount, wants another free ‘top up’ of their toxin treatment, or says their expectations weren’t met when the before and after photos clearly show an excellent clinical outcome. 

When these frustrations mount, it can be difficult for some practitioners to stand their ground and do what is best for their patients and their practice. In fact, when I had days like this in my early years of practising, I used to say I wanted to quit aesthetics and open a cake shop! 

However, in the nearly 20 years since I first opened my practice, I have developed some strategies and methods for not being a ‘patient-pleaser’, and therefore operating in both the patients’ best interests and mine. For those who perhaps also struggle with managing difficult patients, allow me to suggest the following.

Set boundaries

When colleagues ask me about how to best approach challenging patients, often the best tip I can give them is to set boundaries. It seems obvious, but this can sometimes be hard to do when faced with a highly sensitive, anxious or needy patient who may have unrealistic expectations or just ask for too much. In these cases, I’ve often found that these patients simply need to hear what they don’t want to hear, for their own best interest. “Easier said than done,” I hear you say! Remember that as medical practitioners, we have a code of conduct to uphold, and it’s important to explain to patients why we can’t and shouldn’t chase every line, how all humans are naturally asymmetrical and how we are striving for improvement, not perfection.

When unrealistic expectations, for example, make these reality check conversations necessary, the best way to approach setting a boundary is to respect and acknowledge the patient’s concerns, but then bring the conversation back to what, in reality, can be achieved. I tend to focus on the positives – for example, what we can do first – but then gently explain what they don’t want to hear, while reminding them that as their medically-qualified practitioner, I am actually best placed to advise on what can be accomplished realistically and safely. When done with respect and positivity, even the trickiest patients respond well to receiving what they may have perceived as bad news in the first instance.

After all, remember that to be the best practitioner possible, it is necessary to act as the patient’s advocate, not their friend. If a patient is asking for too much, try to gently re-draw that patient-practitioner line by redirecting the conversation after addressing their concerns so that the boundaries remain clear.

I recognise that for those practitioners who are naturally accommodating (such as myself), it may not come easily, but boundaries are so important to caring for ourselves as practitioners so that we can then provide our best selves and services to our patients. Assertiveness – not aggression, as these are two very different things – and consistency are key for ensuring boundaries are respected. That’s why I urge ‘people-pleaser’ practitioners to not become ‘patient-pleasers’ – I promise you don’t have to be both, which leads me on to my next point.

Create a separate work persona

If you read my above point and thought ‘ok, but Julie, I’m NOT an assertive person’, that’s fine. You don’t naturally have to be, but you should lead your patients to believe that you are. That’s why I recommend dividing your individual personality from your business persona – separate who you are from who you act like at work. When you step through the door of your clinic, become your alter ego.

If this sounds like a formidable task, it may be one of those situations where you have to ‘fake it till you make it’. You should still be your authentic self at your core, but take on another persona that is more suited for a clinical environment. To do this, I find it helps to visualise myself physically changing my hat – for example, every morning I take off my ‘mum’ hat, and put on my ‘work’ hat. If I tried to wear two hats in real life, they wouldn’t fit! This is the same when it comes to creating that work persona. Regardless of what is going on in my life, my patients have a certain expectation of me, which I need to meet – so for them, as soon as I step into my clinic, I become Nurse Julie.

In addition to becoming a more assertive, clinically minded Julie, I also leave anything non-work related at the door, to become my best practitioner self for my patients. And in turn, this helps me maintain that professional distance and clear boundaries while simultaneously building trust with my patients.

Build and utilise your network

Lastly, it is so important for every aesthetic practitioner to build a network. This can be an isolating industry, and dealing with demanding, sensitive, specific, needy and/or anxious patients can take its toll. It’s no wonder that many of us want to take to the hills at times. Some practitioners do indeed end up leaving the industry due to fear of complications, the stress of patient complaints and general burnout. Even if they are the most skilled injectors, some haven’t focused on developing the skills to address difficult patients.

I would surmise that a large part of this is due to practitioners being on their own in practice, especially those who no longer work in the large multidisciplinary teams of the NHS. These fears, worries and negative experiences fester and result in mental exhaustion and feeling drained. With a support network, however, these things don’t have to manifest and it is far easier to avoid making a mountain out of a molehill. It is then possible to air any concerns about certain patients, or discuss more clinically difficult cases with experienced colleagues.

Finding one’s tribe is one of the most important things to do when getting started in the industry. You can do this by connecting with local practitioners via associations like the British Association of Cosmetic Nurses (BACN) or the British College of Aesthetic Medicine (BCAM), and joining the complications groups such as the Complications in Medical Aesthetic Collaborative (CMAC) or the Aesthetic Complications Expert (ACE) Group World. You can also find mentor or coaching groups, or simply meet up with similar practitioners at conferences such as ACE and CCR.

Reflection on one’s practice with colleagues leads is also a huge help – it leads to empowerment and feeling more capable of facing challenges head on. Furthermore, this reflection can lead you to realise what you want to work on in your practice and your skillset. There are courses you can attend where you can not only develop skills and address your trigger points, but connect with the other delegates on the course who are motivated to learn the same skills as you are.

Don’t be disheartened by the difficult patient

Overall, we all know that in any industry, there are occasionally frustrating interactions between those receiving a service and those providing it – in fact, when I used to feel that I wanted to leave aesthetics and open a cake shop, my friend reminded me, “That would be nice, until you give someone food poisoning!”

In an industry such as aesthetics, though, when we are dealing with patient insecurities and changing their physical appearance, this can be heightened. I have found that practitioners need to not only be skilled with a needle in their hand, but have the people skills and the courage to guide patients and address difficult situations. 

It is important to know, though, that you don’t have to be born with these skills; they can be developed over time with some mental shifts and behavioural changes and lots of practice over time in implementing the tips above, for example. It is a huge undertaking, but I feel that anyone who doesn’t think they need to hone in on these skills is a bit misguided. I made these changes in my own practice, and 20 years later, I’m still here, changing my hats. I never did open that cake shop after all.

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