Handling the Angry Patient
Not all patients are happy to see their doctor. How do you stop angry patients from going over the edge?
In the midst of a hectic glaucoma clinic, an uncomfortable patient encounter may quickly become unpleasant, negatively affecting everyone in the office. However, with some forethought and mental preparation, such outcomes can often be avoided. The following points may help you manage a patient who has reached—or is reaching—the boiling point.
Being a glaucoma patient is generally an unhappy and unexpected life circumstance. The experience can be particularly stressful when the patient has either already experienced significant vision loss or is at imminent risk of losing his or her vision. In this emotionally charged context, some patients lose control of their compensatory mechanisms for handling stress and thrust their anger and frustration upon glaucoma doctors and staff.
Fortunately, there are almost always signs to indicate a patient’s deteriorating emotional status. A tense posture, a clenched jaw, or a curt response to a staff member’s greeting can indicate that a patient is near his or her breaking point. It is important to be on the lookout for these signs and to train staffers to recognize signs that call for early intervention.
GAME PLAN FOR DEALING WITH AN ANGRY PATIENT
Just as firefighters would never approach a three-alarm fire without a plan, having a strategy for reasoning with an angry patient enables glaucoma specialists to respond quickly and appropriately to a tense situation. Here are some tactics to employ:
1. Don’t allow yourself to get angry or frustrated. Don’t try to shut down the patient by using phrases such as stop yelling or calm down. Make eye contact with the patient, ensure that your body language remains loose and open, and just listen.
2. Avoid justifying the situation or defending your actions. This will only add fuel to the patient’s fire. He or she may indeed be looking for a fight. Instead, do not respond until the verbal barrage is over. Speak firmly but gently, call the patient by name, and acknowledge his or her feelings, particularly if the complaint has validity.
3. After the patient has quieted down, ask him or her to provide a solution to the problem. Offer up some options to try to reach an acceptable arrangement. Because each situation is unique, remember that many insurers have a hotline that can provide assistance with risk management.
4. Know that it won’t always work. Recognize that on rare occasions, a patient may refuse to calm down and may demonstrate irrational, belligerent, or threatening behavior. Do not hesitate to contact security or police. It may be prudent to establish a coded phrase to use with staff that can be used in these situations.
Generally speaking, a nasty patient encounter does not just happen all of a sudden. Proactivity can often avert an angry patient encounter by defusing the situation before an explosion. Doctors or staff should try to acknowledge and address a patient’s distress before he or she stews on it for 30 to 40 minutes in the waiting room. Such early action is best for the patient, the physician, the staff, and other patients in the waiting room.
KEEP COOL WITH A GAME PLAN
Although patients’ conditions lead to stress, we need to acknowledge that glaucoma practice itself comes with its own stresses. Glaucoma specialists are compulsive high achievers capable of operating at an intense level, but pressures exist on a daily basis from many sources, such as increased reporting requirements, rising patient volumes, and declining reimbursement. During a busy clinic day, one angry patient can be like a match that sets off a ruinous explosion.
Like our patients, we may have a tendency to become defensive when attacked, but it is imperative that we keep our cool in order to defuse an angry patient. I have found that the best way to achieve this is by formulating a game plan. (See Game Plan for Dealing With an Angry Patient.)
Remember that an important part of our role as physicians is to demonstrate empathy, whether or not the patient is deserving of it. This is not to say that we must tolerate bad behavior, but each patient should be given an opportunity to respond to a doctor’s attempt to address his or her concerns. Reassuring a patient that you take his or her concerns seriously can be very powerful. Saying something like, “I understand your frustration and can appreciate that you are upset,” can go a long way toward de-escalating tension in most of these situations.
DOCUMENT UNPLEASANT ENCOUNTERS
Depending on the severity of the situation, it may be prudent to document complaints, attempts to resolve them, and results of such actions in an incident report. If you feel that the trust necessary for an ongoing doctor-patient relationship cannot be recovered or maintained, arrangements should be made to terminate the relationship and refer the patient to another provider. Moreover, immediate dismissal may be warranted if the patient acts in a way that is violent, abusive, or threatening to you or your staff. If you decide to terminate your relationship with a patient, be sure to take the steps recommended in a publication by the American Medical Association’s Specialty Society Medical Liability Project, which details what should be conveyed to the patient and how to provide such information.1
AN UGLY PART OF THE JOB
Approaching an angry patient will always be a highly unpleasant challenge. Try to resist the human impulse to respond to the patient in kind; remember your role is that of the physician, and focus on trying to do what is right for the patient’s vision and health.
1. Risk Management Principles & Commentaries for the Medical Office. American Medical Association/Specialty Society Medical Liability Project, Chicago. 1990:14-15.
Allen Chiang, MD
• attending surgeon, Wills Eye Hospital Retina Service
• physician, Mid Atlantic Retina
• assistant clinical professor of ophthalmology, Thomas Jefferson University, all in Philadelphia