9 Patient Personalities Every Clinician Will Likely Encounter (and How to Treat Them)

By Lanie Hefferly, MS, OTR/L
Occupational Therapist

Our profession is extremely personal, and one of our greatest skills is our therapeutic use of self. But even with our best efforts, there will be some patient personalities that you may not mesh well with.

Below are some common personalities every clinician is likely to encounter throughout their career. These personalities are loosely based on the Enneagram, a personality typing system, and should be taken light-heartedly. Let’s dive into the 9 patient personalities and learn tips and tricks on how to best treat them.

1. The Grumpy One

You know them, you hate to love them. They’re unlikely to tip their server, they report their neighbor for a noise violation, and good luck to you if your dog pees on their lawn. They will not be seen before 9:00 and not after 3; not at lunch, and not on Wednesdays or Fridays. If you show up a minute late or leave a minute early, you are fired.

Pros: They are perfectionists. Once you earn their respect, they are the hardest workers. They can turn out to be the most rewarding patient because they are the ones whose lives you can literally change the most and lift their spirits.

Tips: They really value time and order. Be punctual, reliable, and prepared. They may be sensitive to criticism, so don’t come on too strong when correcting them, and don’t tease them! Affirm their effort and support them when they need breaks.

2. The Hospitable One

The “I’m fine! What can I do for you?” patient. This person will get you a perfect seat and offer you a drink every visit. They want to know everything that is going on in your life. But be careful, this could be a technique to increase their rest period. They might be your best friend or your worst nightmare by the end because when you start buckling down and making them work, they can get offended. They might beg you for more therapy than they need, and they might try to gift you something you can’t accept.

Pros: They are incredibly appreciative of your time and will often show you! They listen and take your advice. They are often very easy to schedule because they make you a priority.

Tips: Set boundaries. Be very clear during the evaluation of the end goal and timeline. Give them 5 minutes in the beginning for small talk and set a timer. Maybe schedule them for the end of the day so you don’t feel rushed or feel like you have to cut them off.

3. The Achiever

These people are social butterflies. The achiever is usually quite busy and can be difficult to schedule. They might have been a previous athlete and they are competitive! They want to know how they compare to others their age. They can be highly distractible and may be focusing on the forest instead of the trees. They can be disappointed when they aren’t progressing as fast as they like and may try to skip some steps along the way. 

Pros: They like success, so they work hard!! You can push them and they will exceed your expectations.

Tips: They need a high-energy environment and measurable goals. They love a functional outcome measure, and the goals need to be achievable to keep them motivated. They don’t take disappointment well, and they like encouragement and praise.

4. The Dramatic One

They have high expectations for therapy. They believe you are the savior who has come to fix the back pain they have had for 40 years. One day you are BFF and things are progressing well, and the next they no call no show, or refuse care. They may try to quit therapy altogether because they’re still having pain after 3 weeks of giving it their all. They tend to focus on the negatives and often feel misunderstood.

Pros: They are vulnerable and honest. You don’t have to dig deep to find out the problem, they will offer it up freely.

Tips: Don’t give in when they push you away. They are testing how much you care. Listen to their concerns. Give them examples of past successes and realistic hope for the future, but don’t be overly positive or negate their feelings. You must affirm that what they feel is valid while giving them authentic examples of how resilient and strong they are.

5. The Protocol Patient

Therapy is not their cup of tea and they don’t want to be your friend. They want to know your expertise. Don’t veer off course because they know their stuff. They might have even been a nurse in their past life. And you better sanitize everything you touch them with. This person usually has “analysis paralysis” — they know what they need to be doing, but they need you to implement the plan.

Pros: This person truly values their privacy and independence and it can be a huge motivating factor in therapy.

Tips: Don’t be too intrusive. They are here for business. Be clear and direct, limiting your word count. With ADLs, give them the most privacy you safely can. Again, they usually aren’t unsafe so you probably can give them some space. If you are going to veer off from the plan, give them research to back it up.

6. The Repeat Offender

Ok, they love therapy. They know their insurance benefits and they know their rights. You are not discharging them until they meet their goals. They have had therapy on that bum shoulder four times and it always helps. They love the arm bike but lifting weight above the head is not happening. 2 years ago they did a shoulder press and it threw their neck out for weeks! They do not push the envelope. They haven’t moved that arm for six weeks. They haven’t bent 5 degrees since that hip replacement, forget putting weight on it.

Pros: They are so loyal. Do a good job and they will have their whole neighborhood seeing you.

Tips: Don’t let them run your program. Instead, reassure their autonomy and teach them how to progress their HEP. Take their anxiety seriously, but help them focus on the best possible outcome instead of the worst. Be kind and answer all their questions. Be comfortable having that conversation though when care is no longer skilled!

7. The Optimist

Call it the placebo effect, but this person hits their goals every time. They are sure they are getting better and by golly they are! They are risk-takers, breaking all their precautions. They are highly distractible and when you get done treating them, you’ll look at your blank treatment note and think, “What just happened?” It takes you 30 minutes to write it up because you did 75 exercises and didn’t write any of them down. You don’t even know how you came up with all those exercises. They can be flaky and they probably don’t do their HEP.

Pros: This is obvious, but who doesn’t love an optimist when it comes to rehabilitation? They push us to be better, more challenging, and hopeful.

Tips: They need spontaneity. Try not to schedule them out too far in advance and be creative with your treatments! Try to be as flexible as possible. Be attentive to their stories, but gently keep them on track. Be brief in criticism. Make their HEP fit into their daily life like, “While you’re brushing your teeth do 10 calf raises”

8. The Boss

You will get serious imposter syndrome with this patient. You are on your A-game the whole time. They may not know their head from their foot, but they will make you feel like your license is on the line for that one time you mistook their right from their left. This person might make you cry, but you should know that even though they make you feel dumb, they don’t think you’re dumb. They really respect you or they wouldn’t be wasting their time.

Pros: They actually do their HEP and get better. They don’t miss any appointments and take your visits and recommendations seriously. Before you know it they are championing you.

Tips: Do not take their criticism personally and don’t let them push you around. They may be testing you. To be straightforward, this is the one who appreciates constructive criticism. They need a high-intensity program, they must feel like they are being challenged.

9. The People Pleaser

This is your most agreeable, “easy” patient, but one that could turn out to be your biggest failure if you’re not careful. You have to dig deep to find their goals because they are going to ask you what you think their goals should be. You might spend 6 weeks working on shoulder ROM when they tell you their husband has gotten that bowl down from the high shelf for 50 years and really it’s kneading the dough that’s the hard part.

Pros: They are so agreeable, easy to schedule, and easy to get along with.

Tips: They are low energy and need a lower intensity program, think yoga or Tai Chi. Be careful not to take advantage of them, they are very flexible and easygoing. Be direct in your expectations of them, and find what’s important to them or they will not be very committed to your program.

Every Patient is Unique

Each of these personalities is meant to give you some ideas on how different patient personalities may respond to your treatment and how to best connect with them. But while you may have chuckled to yourself as you read through these, remember that taking the time to get to know each patient individually is ultimately the most important factor.