There was an article by a Dr. Jeffrey Keller, a physician in a jail, where he described several of the tactics used by criminals in the jails and prisons to manipulate doctors to try to get what they want.  Dr. Hughes sees all of these tactics on a regular basis with only very slight variation.  In other words, he has seen this behavior many times before, but patients seem to think that lying and deceiving will work to their advantage to their ultimate end goal of getting free surgery or some type of remuneration.

Exaggeration

This tactic is used when someone tries to make their circumstances special when compared to other patients. The patient will attempt to make their need or want worthy of your “special consideration”.

  • “I have never experienced pain this bad”
  • “I fear for my life”
  • “It’s so much worse now than it was last night”

Belittling

Manipulative patients will often attempt to make your contribution or job role seem unimportant or undervalued.

  • “The other surgeon said you did a terrible job”
  • “The other doctor was much better”
  • “You are not an expert in this”

Splitting

This is when you’re compared to another doctor who would (or did) give the patient what they wanted.

  • “I have never had any problems with my previous surgeries.”

Threatening

Threatening behavior from patients can come in several different forms. Patients may communicate threats of physical violence either verbally or nonverbally.

  • Verbal: “I will come right off this bed and at you if I do not get something for pain.”
  • Non-verbal: Patient may clench fists, tense muscles or narrow eyes.
  • A patient may also make threats in the form of complaints.
    • “If you don’t give me what I want, I will come down there.”
    • “I have a lawyer and you will be hearing from my lawyer”

Fawning

Sometimes patients use exaggerated flattery (fawning) as a way to manipulate you into getting what they want. We do not always know when we are being manipulated because fawning can be very subtle.

“I am so glad you are here tonight! I sleep so good when you are my nurse and I brag about you to everyone.”

Fawning can also take on a flirty or sexual innuendo.

Filibustering

Filibustering is especially exhausting because the patient is so relentless in their demands, you finally just give in.

  • “I will come back to your office every day until I get a prescription.”
  • “I am going to keep calling and emailing until _fill in the blank.”

The Straw-Man Victim

A manipulator sometimes accuses the doctor of acting against a protected class instead of their clinical assessment or findings.

Champions

A champion is someone that pleads the patient’s case from the outside and is usually a family member.

Champions often use the same techniques as their relatives.

Self-harm

There are patients who deliberately harm themselves to force you to do something they want. Examples would include:

  • A patient who deliberately falls
  • A patient who deliberately avoids followup and or causes harm to a surgical site
  • A patient who refuses to sign medical records releases