Two weeks ago, I took care of a mom in labor who was particularly rude to me from the time I walked into the room until after she gave birth to her new baby. Once the baby was swaddled and in her arms, she smiled sweetly and mumbled an apology for her words and actions during her labor.

I laughed it off. As far as I’m concerned, a woman can say or do anything to me while she is in labor, and all will be forgiven. I once had a mom throw a cup of ice at me while pushing.  A woman isn’t always in the best frame of mind during childbirth, and often the nurse, midwife or obstetrician is the easiest target. It’s all part of the job.

But rude behavior during an office visit is completely different, and something I have a difficult time tolerating. Just last week I had a young patient who was so busy sending text messages while I was taking her history that I had to repeat most of my questions multiple times. I finally asked her to put her cell phone away, pointing out the large sign that instructs that all cell phones are to be turned off during visits.

Chronic lateness is another pet peeve of mine. I understand unexpected circumstances such as traffic or getting lost, and our office gives a standard 15-minute grace period, but I have patients who tend to show up more than half an hour late for every visit and then get disgruntled when we reschedule their appointment. I try my best to stay on schedule and have respect for my patients’ time, I only ask that they return the courtesy.

Every now and again, a patient will be verbally abusive to the staff or a provider. I am aware that there can be situations that are certainly upsetting and frustrating for patients. Our office staff is adept at handling these patients calmly and politely. No one deserves to be berated though, so this is often grounds for patient dismissal from the practice, or at least a serious discussion that this type of behavior will not be tolerated.

Difficult interactions with patients can damage or preclude a therapeutic relationship between provider and patient. Having set office policies that outline the best ways to manage these situations is important, though that doesn’t always solve the problem.

Discharging a patient from a practice is certainly not something anyone wants to do on a routine basis and can negatively impact a practice’s reputation. How do you best handle difficult patients or rude behavior at the office?

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.