The Angry Patient

The Angry Patient

The angry patient is a like a thorn suddenly
Pricking the finger of the unwary doctor
But, perhaps, sticking there with great pain and consternation
The doctor trying some way to pull it out
And not push it in deeper

I want to expound a bit on my poem. In our American and perhaps generally within the western culture, physicians will experience sometime in their practice angry patients. The anger may be expressed directly to the physician because of some sort of unhappiness which was experienced by the patient. The experience could have been happened during care by a previous physician but the patient is entering the new relationship with much suspicion and may want to set control. The patient may be dissatisfied by something currently experienced and may represent unhappiness with the physician or the office. Or sometimes the anger may represent an attempt by the patient to exert control in any way because of anxiety and fear about the patient’s own illness for which therapeutic control is lacking. Whatever the basis of the anger, the presence of an angry patient confronting the physician presents a challenge to that doctor. There is the natural reaction for the physician to be immediately defensive and return anger with a similar behavior except for one thing.. the basis of all medical care: the aim of medicine to be therapeutic. And returning anger is not productive and certainly not therapeutic. So what guidelines can a physician use to be therapeutic in the response?

On the website of The Reporter publication by the Texas Medical Liability Trust, I found a great article by Barbara Rose on how to defuse angry patients. I would like to present the article’s suggestions (References are listed in the article):_


• Be curious; ask why they are angry as this
may have a therapeutic effect.
• Don’t be defensive and engage in a power
struggle.
• Listen carefully; this alone may defuse the
patient’s anger.
• Use active-listening techniques — repetition,
summary, validation, and empathetic statements.2
When physicians are uncomfortable interacting
with a patient, a barrier to effective communication
exists. “Being aware of the tension, identifying the
barrier, and acknowledging with the patient that
there is difficulty in the relationship are important
steps in re-establishing understanding between a
patient and clinician.” 2
In Anger Management Techniques, J. Alfonso
describes visceral responses that may defuse a heated
encounter with a patient.
• Maintain slow and steady breathing.
• Monitor the pace and tone of your voice. Speak
slowly and calmly.
• Maintain open body language as a nonverbal
sign of listening. 3
Also, avoid standing with your hands on your
hips, in your pockets, or arms crossed as this body
language connotes a defensive reaction.
What if the source of the anger legitimately rests
within your practice? A patient who experienced
difficulty in scheduling an appointment, a long
waiting time, or unresponsive staff members will
very likely direct anger toward the physician. Use
the techniques listed above. Get specifics and give
the patient assurance that the matter will be acted
on and resolved. Don’t avoid the angry or dissatisfied
patient. Being an advocate for your patients will
enhance your effectiveness. “As difficult as it may
be, the more you talk with and listen to an angry
patient, the more likely you are to avoid converting
an incident into a claim.” 4
Another model for dealing effectively with critical
and angry patients triggered by events in your practice
suggests the following:
1. Make a disarming statement, e.g. “You are
right. You did have to wait today.” This is nondefensive
and validates some of what the patient
is saying.
2. Make an empathic statement, e.g. “Your time is
important and it is frustrating when you have to
wait.” This reflects putting yourself in the
patient’s position and understanding his or her
needs.
3. Make an inquiry, e.g. “What can we do to
resolve this problem today?” This demonstrates
your shared relationship and interest in the
patient and may move the exchange to a productive
solution. 5

These are all excellent suggestions. But, physicians are human too and an angry patient can strain sometimes the strongest self-confidence. However, I think if the physician looks at the patient’s expression of anger as a patient symptom and tries, with the help of these guidelines, to understand and then treat the symptom, the experience will be something positive and perhaps of value to all involved.

I would be most interested in reading from my visitors whether they, as patients, displayed anger at their physician and how the physician responded. Did the doctor demonstrate any of the guidelines as noted above? What was the outcome? Again, no names please. ..Maurice.