Practice Management

Survival Tips: How to Handle 4 Kinds of Difficult People

By Jennifer Jabaley, OD

Dec. 13, 2017

We’ve all watched movies or TV shows that portray difficult people in the workplace. Usually, we laugh at these characters because their behavior resonates. We’ve all encountered mean people. It’s not funny, however, when we actually have to work with these types of people.

According to, 75 percent of workers state they have to interact with bullies or difficult people in their workplace. Additionally, it’s noted that the holiday season seems to be the time when people are on their worst behavior. Holiday “joy” can be stressful.

Workplace hostility is not just aggravating, it can directly impact your health. Interacting with a mean-spirited person can lead to increased depression, anxiety, high blood pressure and insomnia (Workplace Bullying Institute). In situations where the bully is a co-worker, employees can distance themselves by moving desks and avoiding interactions. But what can we do when the bullies are our patients? When avoidance is not an option?

In The A-hole Survival Guide: How to Deal with people Who Treat You Like Dirt, author Robert I Sutton shares strategies to provide relief, preserve your sanity and build a plan of action for dealing with jerks at the office. Sutton says it’s first important to understand what type of mean person you’re dealing with. Once you identify which type of difficult person you’re facing, you can recognize why it is they act the way they do. Next, knowing what drives the person, you can formulate a strategy and plan for your interaction.

The Strategic Conniver
This difficult person finds a way to get under your skin. They are masters of the back-handed compliment (“Wow, you’re actually smart for a pretty girl”) or the below-the-belt comment. Their remarks are an attempt to bring you down. If you’ve ever seen the movie, “Meet the Parents,” Robert De Niro’s character is a perfect example of this type of bully. Every time he introduces his future son-in-law as “Greg, RN” he is jabbing at the fact that he isn’t an MD. I know several optometrist friends, myself included, who have had to deal with a sly comment about OD instead of MD. This is a classic strategic conniver trying to get under your skin.

Why they act the way they do: In all fairness, this type of person may be acting either consciously or unconsciously. In the case of a conscious, purposeful insult, most often the strategic conniver is jealous. If the comment, or actions, are unconscious, it may be a case of a socially awkward person who unintentionally hit a nerve.

What this person really needs: In the case of a purposeful conniver, they need to feel better about themselves. In the case of a socially awkward blunder, they want to feel comfortable in social situations.

Strategies for dealing with this type of person: If you suspect the patient is socially awkward, and said something offensive or insulting without intention, simply ignore it. Once the words were out of their mouth, they probably were horrified. However, if the insult, or sly backhanded compliment, was intentional, you can either ignore the comment, pretending like you didn’t even realize it was backhanded, or you can take the high road and model sincerity by giving a compliment to them.

Machiavellian Schemer
These people enjoy playing dirty. Their brains actually light up when you argue with them. They enjoy inciting debates and watching you get ruffled. These types of people have loved the recent year of political debates and controversy. They are supreme devil’s advocates and will argue until they win.

Why they act the way they do: Most often these people feel unheard in their jobs or life. They feel overlooked.

What this person really needs: These people, deep down just want to feel heard, to feel smart and correct.

Strategies for dealing with these types of people: During your exam, keep to your agenda. Don’t be sucked into their plan for conversation or debate. If you do find yourself immersed in a discussion with extreme views on politics, current events, or local happenings in your town, vigorously agree with whatever side they are on. Achieve common ground and immediately end the discussion and resume your exam. There is no winning against this type of personality.

The Narcissist
This person acts superior and confident. They are the classic know-it-all. They are a conversation hoarder, an interrupter and a status, or name, dropper. These patients may dispute your expertise, and blame others for unfavorable outcomes.

Recently, I had an encounter with a patient I’ve been treating for years. He’s a general surgeon in his mid-forties with moderate glaucoma. His compliance is sketchy, and at his last appointment I noticed some changes in both his fields and OCT. I had a stern talk with him about losing vision at such a young age, especially in his career where acuity is critical. I suggested changing to a combination medication that would make compliance easier. He refused, said his pressures weren’t that high, and the changes were not significant enough to warrant changing a medicine.

Why they act the way they do: Narcissists have very fragile self-esteem. They are extremely vulnerable to criticism. I realize now that I made a mistake by assigning blame to him for his progression. By saying that his compliance was an issue, it put him on an extreme defense where anything I suggested would be combated.

What this person really needs: Narcissists need to feel worthy.

Strategies for dealing with this type of person: Narcissists do well when advice is nestled inside of flattery. In retrospect, I never should have commented on the patient’s poor compliance. A better way to manage him would have been to link my management of his glaucoma with his high-achieving career.

Narcissists respond better when they feel like you are impressed by them. If I had said something along the lines of, “The fact that people’s lives are in your hands everyday makes me want to make sure we preserve your vision as best we can. You’re doing great, but in an effort to make sure I’m doing the best I can to help maintain your vision, I’d like you to consider trying a new drop.” With narcissists, it’s also important to stand your ground without justification.

These are the patients who will quote WebMD to you and try and make you feel like they know optometry better than you do. Don’t get defensive, but be firm. In the end, with this patient, I called my husband (we practice together) in for a second opinion. He agreed with me that we needed to increase to a combination therapy. Having two authoritative opinions was enough to convince him that he needed to adhere to our clinical judgement.

The Petty Tyrant
These are the mid-level managers who are treated with disrespect by their bosses, the passive husbands or wives who are controlled by their spouses, or anyone mistreated by superiors. When these people finally break free from those who wreak havoc on their days, they take out their insecurities on anyone they come in contact with. These are the patients who answer their cellphones in the middle of the exam, who try and get special treatment, asking for special accommodations.

Why they act the way they do: These people feel undervalued. They try to become stronger and build up their ego by finding power wherever they can.

What this person really needs: This person needs respect. It’s not hard to find sympathy for these people when you consider what their daily life might be like.

Strategies for dealing with this type of person: Reach out to these people with kindness. Shift your understanding, and try not to let their desperate attempt at power annoy you. If this person asks for a favor, like having two contact trials instead of just one because they have an important trip to make, allow it, within reason. Empathize and realize their behavior reflects their own struggle, while maintaining your rules and schedules.

Sometimes at work, we have to endure a bully’s bad behavior in our exam room. By identifying what personality type you are dealing with, and understanding where the behavior comes from, you can assemble a strategy to best deal with each problematic patient while maintaining your sanity.


Jennifer Jabaley, OD, is a partner with Jabaley Eye Care in Blue Ridge, Ga. Contact:

To Top
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
Subscribe Today Free...
And join more than 25,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.
Subscribe Today for Free...
And join more than 35,000 optometric colleagues who have made Review of Optometric Business their daily business advisor.