dealing with difficult patient

• 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. 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.”
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. 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.”
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.