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Managing difficult clients. A reflective piece written by a graduate dietitian.

As a graduate dietitian working in private practice, I have worked with a range of personalities, unfortunately including some disrespectful and aggressive clients. I felt most vulnerable a few months back seeing a woman in her seventies who worked in a management role. Before bringing her into the room, she complained to reception that she had been waiting three minutes to see me (although my previous client arrived a few minutes late after taking a family member to hospital), and later told me that she thought she better give me ‘a wriggle’ as she was waiting. This meant that before even commencing the consult, I felt disrespected, but continued on, trying to best assist them in the 20-minute initial bulk-billed session which we had allocated.

In the follow-up appointment a few weeks later, she walked in and glared at me, very reluctant to sit down until I mentioned ‘that’s ok, you can take a seat’. At this point, she loudly exhaled and sat down. She then proceeded to tell me how useless I was and how she hadn’t done anything which we discussed in the first session. Jumping on the scales she angrily cried ‘yep, no change!’. She complained accusingly that there was ‘not even a mention of her osteopenia’ in the past consult, when upon reflection, I realised she had never mentioned this to me when I asked about her medical history. When I attempted to speak, she cut me off declaring I was not an ‘expert’. She then grumbled, ‘no one ever knows what they’re talking about’, she made more critical comments, watching me very closely and with a sense of satisfaction. It was evident she was enjoying herself. I felt threatened- my heart was pounding, I was shaking, my mind was racing, I struggled to think clearly. I felt like I needed to leave the room but was too scared to head towards the door which was closest to where she was sitting in case she became physically aggressive…

In retrospect, I could have taken control of the situation more clearly, mentioned that I was there to help her, to work with her, and not to judge her. I also found that panicking, not trusting in my own previous assessment (with regard to the client not mentioning osteopenia) and starting to doubt myself were not helpful. On reflection, I also realised that the client must have had healthcare appointments in the past which she found unhelpful, and perhaps felt unsupported. I also realised that it may be difficult for someone of her age to hear advice from someone who was much younger than her.   

From the above example (and many more), it is probably evident that private practice can feel isolating at times, and as a young female, it is easy to feel vulnerable. After speaking with colleagues, my mentor, broader allied healthcare workers, and researching this area, I realised that I am not alone, and many new graduates are in my situation.

I decided to write an overview on the approaches I have used so far which have been useful in managing difficult clients. It is important to speak up against unacceptable behaviour from clients, seek advice when unsure, and not be afraid to reach out if you need supports. After all, we have each worked hard to be where we are today and deserve to be treated with respect, just as any other healthcare worker should be.

Tips to managing difficult clients:

1.Do not take client feedback or disrespect personally. From my experience, difficult clients have one or more of the following features:

  • Been forced to attend the consult by a GP or family member and are feeling ambivalent about change and/or or feel personally offended that they have been asked to see a dietitian (feeling that a dietitian will judge them, even before giving us a chance to speak).
  • Are actually desperate for help (such as with debilitating IBS) and are frustrated and burnt out from living with a chronic condition for so long.
  • Have personal issues (relationship, financial, employment, housing) which are impacting on the consultation.  
  • Are feeling frustrated with previous negative healthcare experiences

2.Meet clients with empathy and validation wherever possible and ask them what they would like to focus on in the session. This is where agenda setting can be useful, clearly ask the client what they would like to get out of the consultation.

3.If the client is aggressive and does not calm down, know where to draw the line; if you feel threatened at any point, your safety as the health professional is the number one priority. This is where being assertive, and remaining as calm as possible, is crucial. Make sure you know the safety plan for the clinic (or write one up if you are working as a sole trader). Do not be scared to press the duress alarm, take a moment out for yourself, or if your safety is not directly threatened, pause and ask the client if they have finished speaking, and then let them know that you are there to help them, not to judge them and that is not ok to speak to a health professional the way they are (as I should have done in the above example).

4.Do not be afraid to terminate a consultation early. In the example discussed, on reflection I realised I should not have tolerated this clients behaviour . It is ok to put your foot down as a health professional and let the client know what is acceptable and what’s not.

5.Take each opportunity as something to reflect on and learn from.  

6.Know that you are competent- if you feel uncomfortable with a client, trust your gut and do not be scared to stand up for yourself.

7.Reach out if you ever need any help or support- contact your colleagues, mentor, debrief with friends/ family. Consider getting professional support if the way you have been treated is taking a toll on your mental health.

Resources and references:

Australian Institute of Professional Counsellors (2010). Managing challenging clients

Cerit, K., Karataş, T., & Ekici, D. (2020). Behaviours of healthcare professionals towards difficult patients: A structural equation modelling study. Nursing ethics, 27(2), 554-566.

Clay, R. (2017). Coping with challenging clients.

Lewis, K. (2021). Student to professional: tips for transitioning into the workplace

Royal Australian College of General Practitioners. (2011). Aggressive behaviour.