The angry patient: 6 strategies to bring the pressure down in a consultation


26 Nov 2018

Specialists are generally loved and championed by their patients, but occasionally may be the focus of their anger.

When patients are already anxious about their illness, irritation over issues such as long waits, brief consults and big bills can erupt in anger.

“The diagnosis and treatment of illness can be a very stressful time, and those feelings can occasionally manifest in frustration, anger and aggression,” says Dr Rebekah Laidsaar-Powell (PhD), from the School of Psychology at the University of Sydney.

Practice issues such as lengthy wait times and the cost of treatment, or communication problems including inadequate explanations and a perceived lack of empathy are common sources of patient anger.

Other reasons include medical grievances about a delayed diagnosis, being in pain or reacting to bad news.

“Managing this type of situation is not something that comes naturally but is a skill that is learned and practiced,” says Dr Laidsaar-Powell, who has co-authored guidelines on handling difficult patients, developed by a team at the Chris O’Brien Lifehouse, University of Sydney.

Try these six strategies next time emotions run high in a consultation.

1. Read the signs 

Being alert for the first cues of tension and distress is a crucial step in defusing a tense situation.

Yet clinicians don’t always recognise the early signs, National MDA executive manager, Professional Services, Dr Sara Bird says.

“Sometimes we’ve had complaints about a doctor, and they have been completely oblivious that anything was wrong, or had happened during the consultation,” Dr Bird said.

Physical signs can include a tense jaw, fists or posture, a louder voice, or other body language messages such as crossed arms, staring or finger pointing. Other clues include a flushed face, dismissive comments and interrogatory questioning.

“It is critical to recognise early warning signs of anger, acknowledge the anger and then address the anger to enable the consultation process to proceed,” Dr Bird says.

2. Keep your cool 

It’s challenging, but essential, to try to remain calm in the face of a patient’s tirade.

“It’s easy to say but hard to do – the first thing to try to do is to keep your cool,” says Dr Laidsaar-Powell.

“Start by taking a moment to gather yourself, take a deep breath, and be aware of your non-verbal communication, for example, keep an open posture, calm facial expressions and tone.”

Dr Bird suggests trying to speak softly and steadily, using the patient’s name, and paraphrasing what was just said, naming the emotions behind the words

3. Listen up

Acknowledging the patient’s grievance by listening in a non-judgemental, active way is the first step in working through an angry situation.

Show empathy by reflecting back and validating the emotions the patient is describing and try to show you’re on the same team, says Dr Laidsaar-Powell.

“Trying to find common ground, building a partnership, and working with the person displaying anger can be a good approach to forming a team.”

“Some health professionals find it helpful to say ‘I’d like to work with you to get through this. How can I help?’”.

4. Relationship repair 

Once a patient feels acknowledged and appears calmer, it’s then about trying to figure out why the person was angry and what the future steps will be to try to resolve the issue.

“Trying to understand the patient’s perspective, open and honest communication, and focusing on a positive way forward can help to rebuild the relationship and get back on track,” says Dr Laidsaar-Powell.

Getting to the bottom of what caused an outburst can take time and attention, but is worth the extra effort to restore trust, according to Dr Bird.

“It can significantly impact on the effectiveness of a therapeutic doctor patient relationship if anger and frustration is not dealt with,” she says.

5. Meet the four C’s

Another approach to keep the dialogue open and constructive is to use one of the ‘Four Cs’. Dr Bird suggests initiating a discussion with one of these four words – Caring, Curious, Concerned or Confused. For example:

“You seem very distressed. I care about you and want to help.”

“I’m curious as to why you said that.”

“ I’m confused about why you might take make this decision – can you tell me more about it?”

Or consider using questions that require a “yes” answer, as it’s hard to stay angry when answering in the positive. The sort of questions that may elicit a positive answer include:  “Have I got that right?” and “Is that what you mean?”

6. Safety first 

Obviously the safety of clinicians and staff is a priority, and if a patient is becoming aggressive, take steps to exit the conflict.

“If the situation is escalating, try to position yourself near a door and (if needed) leave the room,” Dr Laidsaar-Powell advises.

Once the event is over, clinicians need to attend to their own health and wellbeing by debriefing with colleagues or seeking support from a mentor or supervisor.

“Managing an angry patient or family member can impact upon the wellbeing of health professionals, who themselves might feel frustrated, underappreciated, or wronged,” she says.

“Being in these stressful situations can be distressing for clinicians and may be a contributor to professional burnout.”

 Handling a tirade

 A few tips from Dr Bird on managing an angry outburst: 

  • Never tell a patient to calm down or stop yelling.
  • Don’t get into an argument with a patient.
  • Try to wait for the tirade to pass, then ask “what can I do to help?”
  • Focus on the patient’s needs not their manner or words.
  • Avoid becoming defensive or withdrawing emotionally which will increase anger and complaints.
  • Once the outburst has passed, try to calmly outline the next steps to take.
  • Be careful with the use of touch as this may be interpreted as a threatening gesture.

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