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CPC
Corner
Angry
patients and families pose one of the biggest challenges for a clinician,
for encountering this type of tense emotion often triggers one's own
fight-or-flight responses. Any person who is met with anger tends either
to react with anger or with the desire to flee. Remaining calm, professional,
and empathetic to the emotions of the patients is sometimes very difficult
for any of us, but there are communication skills that can be used to
defuse anger and re-establish effective dialogue with patients and their
families.
Patients' anger is often directed at a person or a situation that is unrelated to the physician. The patients' stories need to be heard. Our curiosity about what has happened has a therapeutic effect. By staying curious, we also avoid being defensive about ourselves. By arguing or expressing opinions before letting patients finish their stories, a power struggle may ensue which may augment their anger. Careful listening is just a part of defusing the patient's anger. It also involves some active-listening skills such as repetitions, summaries, validations, and empathetic statements. When a patient is angry about a bad outcome, whether or not medical error was a possibility, empathy can still be used to address the patient's emotions. As clinicians, we usually do not know the details of what has happened in a particular adverse situation, and we often cannot and need not to resolve the problems. The clinician-patient relationship will benefit from such empathetic statements as "sounds like you are quite angry about your diagnosis, tell me more about that." In contrast, a statement of condemnation or judgment may not be very helpful for the patient or the medical group, such as "sounds like the other doctor missed your diagnosis." If the physician feels uncomfortable about a clinician-patient interaction, there is almost always some barrier that is in the way of effective communications. 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. One possible question could be: "I sense that you are upset about something, can you tell me more about it?" Patients assign meaning to what has happened to them. Anger is expressed sometimes as an emotion derived from the consequences of a medical condition, as well as toward the medical condition itself. An example of this is a patient who becomes angry about the disability of an operation for appendicitis, and is also upset about having the condition itself. As clinicians, we don't always consider the meaning behind the patient's anger. Helpful phrases such as "will the operation affect you or you family in any other way?" may bring out issues that are previously unrecognized. The emotions that are unrelated to the business at hand often frustrate us, and we would prefer to pursue the solutions to the medical problems. A physician may need to be in tune with the speed at which a patient is able to vent and move forward. The patient may not be ready to move toward the possible alternatives to a medical problem until his grief is expressed. The following Quick Guide summarizes the behavior and phrases that a clinician can use to deal with the angry patient. Other Quick Guides can be found at the Clinician-Patient Communications Intranet site: http://kpnet.kp.org/cpc/.
Quick Guides When a Patient is Angry About Others
Rationale and Useful Phrases Sometimes
patients arrive at an appointment angry about other experiences they've
had with trying to make appointments, long waiting times, seemingly unresponsive
staff or providers, etc. It is important to address these issues because
they can interfere with your effectiveness as a clinician if you do not
effectively manage the situation.
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