He describes his typical difficult patient as: "too busy for the necessary frequency of visits and/or at-home exercises." In response, Van Anne said he uses "tactful confrontation and (a call for) accountability that addresses the reality of the situation.

"In other words, telling the patient that if they do not make their appointments as recommended or complete their at-home exercises, they can expect to fail.

"This serves two purposes: It shows the patient that you care about their best interest and it will either motivate the patient to participate in the healing process or free up time for you to help patients who 'want' to get better."

Gender and Emotions

Most of the responses received discussed specific types of patients; however, others based their responses on more generalized concepts. For example, Dr. Ron Tripp of Norman, Okla., felt that men, in general, were more inclined to be difficult.

"Men are mentally 'fixers': fix the immediate problem and everything is fine. It is a study-proven male trait," he said. "Unless male patients are at an injury state that may end their careers, they do not accept or comply with treatment plans for restoration of a healthy spine.

"Women are 'pro-active' and are interested in preserving health and taking measures to maintain a health level that is not burdened with 'emergency' conditions if they can avoid it. They comply with check-up recommendations and react to early warnings of problems and address them immediately.

"In the case of men being 'fixers', I stress the importance of prevention versus intervention on health issues," Tripp said.

Some doctors blamed emotions as the primary factor contributing to a difficult patient. In such cases, Dr. George Burdi of Lake Forest, Calif., chooses to take more of a counselor role: "Unhappy patients are very difficult because they seem to have a chip on their shoulder, so anything done is not enough," Burdi asserted.

"One solution is to find something they like to do or talk about and bring conversations around to that topic. Then work in or relate how chiropractic helps in doing that particular thing," he said.

Doctor, Look at Thyself

While most responses we received specified various types of difficult patients, others cautioned their fellow doctors to look at themselves as the potential cause of a problem patient.

"The most difficult patient is created out of our own discomfort," explained Dr. Jim Roth of Milwaukee, Wisc. "We tend to project a difficulty [on] a patient before they actually present it (i.e., report of findings).

"I have a tendency to judge beforehand how much the patient is going to listen to what I have to say, and how much they will actually follow through. Consequently, I have a self-fulfilling prophesy happening.

"After 20 years in practice it is easy to become disillusioned. Insurance companies, politics, patient's preoccupations, etc., chip away at our philosophy of what chiropractic means to us."

Along the same lines of a self-fulfilling prophesy, Dr. Lawton Howell of Las Vegas believes the best way to avoid difficult patients is to attract the ones that you want.

"The attitude and behavioral traits of any patient are often based on your marketing efforts and type of patients you serve," he said. "To avoid patients who are difficult to serve (i.e., late for appointments, no shows, lack of commitment and financial issues), be sure your marketing messages, both internal and external, are targeted to your desired perfect patient."

"Generally, when you attract a patient based on free services, you attract the wrong patient profile. Your marketing efforts always contain a STATED and UNSTATED message. It is the unstated message that has the greatest impact on the success of attracting and retaining the preferred patient."