How to Deal with Difficult Patients: A Rheumatology Office Manager’s Guide

Rheumatology patients often deal with chronic pain, insurance frustrations, and long-term treatment plans, which can lead to heightened emotions. As an office manager, you’re on the front lines of handling patient concerns while ensuring a smooth workflow. Here are some of the most common patient challenges in rheumatology practices—and strategies to handle them effectively.

1. Patients Upset About Long Wait Times

Patients with chronic pain may struggle to sit for extended periods, and delays due to complex cases can be frustrating.

Example: A patient angrily states, “I’ve been waiting for over an hour! My pain is getting worse, and this is unacceptable.”

Response:

  • Acknowledge their frustration: “I completely understand how difficult waiting can be, especially when you’re in pain.”
  • Offer an update: “The doctor is taking extra time with a complex case, but I’ll check on your wait time and see how soon we can get you in.” – Proactively update your patients if there is an emergency throwing your schedule off.  Patients tend to be more understanding if they know what is going on.  You can offer them a glass of water or coffee as well.
  • Provide alternatives: If delays are frequent, consider offering text message updates so patients can wait in their cars or reschedule if needed.

2. Patients Frustrated with Insurance and Billing Issues

Rheumatology treatments often involve expensive biologics, infusions, or specialty medications with complicated coverage requirements. Patients may lash out when faced with unexpected costs.

Example: A patient says, “Why am I being charged $200? My insurance should cover this!”

Response:

  • Empathize: “I understand how frustrating unexpected costs can be.”
  • Explain the Process & Offer Assistance: “Insurance plans often change, I’d be happy to review your benefits with you and contact a representative at your insurance company for further clarification if need be. “We can also provide financial assistance resources if needed.”

Proactive Tip: Educate patients ahead of time by offering financial counseling and clear billing breakdowns before expensive treatments.


3. Patients Who Demand Immediate Appointments

Many rheumatology patients experience flare-ups and want to be seen the same day. However, most specialists book weeks or months in advance, leading to frustration.

Example: A patient insists, “I need to see the doctor today! I’m in terrible pain.”

Response:

  • Show concern: “I’m so sorry you’re experiencing a flare-up.”
  • Provide alternatives: “While we don’t have a same-day opening, I can schedule you for our first available slot or see if a nurse can provide guidance in the meantime.”
  • Suggest virtual options: Some practices offer telemedicine for urgent concerns.

Proactive Tip: Consider implementing a waitlist system to fill last-minute cancellations with patients who need urgent care.


4. Patients Who Are Non-Compliant with Treatment Plans

Some patients may refuse medications, skip follow-ups, or ignore doctor recommendations—yet still expect results.

Example: A patient says, “I stopped taking my methotrexate because I read online that it’s dangerous.”

Response:

  • Acknowledge concerns: “I understand why you’d want to be cautious. There’s a lot of information out there, and it can be overwhelming.”
  • Encourage discussion: “Let’s schedule time with the doctor to go over your concerns and ensure you have all the facts before making a decision.”
  • Offer educational materials: Providing brochures or directing patients to reputable sources can help address fears.

Proactive Tip: Have a dedicated staff member follow up with non-compliant patients to reinforce the importance of their treatment plans. However, remember no non-medical staff member should give patients medical advice.


5. Patients Who Are Verbally Aggressive or Rude

Chronic pain and frustration can sometimes lead to outbursts. While most patients calm down when listened to, some may become verbally abusive.

Example: A patient yells, “This office is useless! No one here knows what they’re doing!”

Response:

  • Stay calm and set boundaries: “I understand that you’re upset, but we do not tolerate yelling or disrespectful behavior.”
  • Redirect the conversation: “I want to help you, but we need to speak respectfully to find a solution.”
  • If necessary, remove the patient: If a patient continues to be abusive, enforce office policies and, if needed, involve security or consider dismissing them from the practice.

Proactive Tip: Have a clearly posted “zero tolerance” policy for abusive behavior to protect staff and maintain a professional environment.

Alternate Tip: Call a staff meeting to discuss dealing with these types of patients Role-play different situations to make sure all staff feels confident and prepared.

Final Thoughts

Managing difficult patients in a rheumatology office requires a balance of empathy, professionalism, and firm boundaries. By proactively setting expectations, listening to concerns, and offering solutions, you can create a smoother experience for both patients and staff.

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  • As a speaker at the first ad hoc meeting of rheumatology practice managers gathered in a single small room at its infancy a decade ago, I’m amazed to see how NORM has blossomed into a high energy organization of depth and professional meetings with parallel break-out symposia between plenary sessions. NORM has truly come of age. This is where the “business” of rheumatology gets learned. The ”guildmanship” for rheumatology practice management is now strong.- Paul H. Caldron, DO, FACP, FACR, MBA, Arizona Arthritis and Rheumatology Associates
  • In a time of demanding changes in the management of medical practices in the US, NORM has been a lifesaver to the community of Rheumatology practices.  NORM has allowed our practice to stay ahead of the many demands of CMS and others payors and has ensured that our practice remains cognizant of new issues that arise in HIPPA compliance, human resources and medical billing to name a few. Sending our Practice Manager to NORM's conferences has been cost-effective and beneficial to our practice because she returns to our office with an abundance of information that otherwise would have taken months to compile. Every Rheumatology practice that wishes to stay on top of emerging issues in practice management should consider sending a member of their staff to NORM's conference.- Michael S. Rosen M.D., Chester County Rheumatology PC
  • Thanks to all those wonderful people in the NORM Network who respond to emails, offering their advice, experience, time, and support ... I haven't even been a member a full year yet and I am amazed at the dedication of everyone who responds to helping via emails and the NORM Organization itself! I have barely had a chance to explore the resources and I have yet to really dive into requests for help still I am silently learning so much and do occasionally offer what I can! Thank you all!- Cheryl Piambino, Kenneth E. Bresky, DO

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