In clinical work we face a lot of angry patients. What do we have to do and how we would respond to their anger?
Patient anger stems from frustration. Disease presupposes a "Why me?" attitude, and when delay prolongs the question and offers no answer, anger increases. A physician should manage this anger, first, by listening, next, by verbalizing possible remedies. Even if these remedies take time to materialize, at least the image of their possibility is soothing.
Many people feelangry when they meet doctors. In addition to that, there are angry patient because their personality is like that. You must train yourself to stay calm. Take slow breaths while concentrating on eye contact.
Compassion and/or consideration may promote healthy relations!
Patience is a virtue!
Period!
Patients should not be angry because it makes the case even worse; anger should be treated first.
Patient anger stems from frustration. Disease presupposes a "Why me?" attitude, and when delay prolongs the question and offers no answer, anger increases. A physician should manage this anger, first, by listening, next, by verbalizing possible remedies. Even if these remedies take time to materialize, at least the image of their possibility is soothing.
If they have serious life issues (as I have) a good doctor should be able to empathise with them and support them if they seek advice from world experts, without letting their ego get in the way.
Dear @Mohamed, I am not a doctor, but I was angry with doctors in some situations. Here is a good reading about "How physicians should deal with angry patients"- good Blog. I think the doctor should listen the patient!
http://www.kevinmd.com/blog/2011/06/physicians-deal-angry-patients.html
Anger Management Program helps patients manage their anger in a healthy way, and direct it toward appropriate targets to restore their quality of life and mental health. Chronic anger is one of the numerous personality disorders we treat to help patients get healthy control of their lives. If a patient’s anger has pushed them toward substance or addiction, we administer a personalized, professional dual-diagnosis treatment plan to treat both conditions simultaneously, which includes:
- Group and individual counseling
- Meditation and breathing exercises
- Anger management education and awareness
- A clear and realistic behavioral plan for the future
http://www.bhpalmbeach.com/programs/mental-health-programs/anger-management-treatment
I think the best way to handle this type of situation is to listen. Usually people are angry with situations of life and in a situation like that just listening becomes an effective therapy. I think this is also our role as health professionals
Furthermore, ""The doctor-patient relationship is like a business partnership," Rankin says. "We need to work together. Trust me to guide you but be willing to do your part."" :)
"How doctors can improve patient interactions" follows!
http://edition.cnn.com/2011/HEALTH/05/26/dumb.doctors.office.ep/index.html
http://www.kevinmd.com/blog/2010/02/doctors-improve-patient-interactions.html
“Touch therapy” or “massage therapy” may sound like some weird Berkeley idea, but it’s got hard science on its side. It’s not just good for our muscles; it’s good for our entire physical and mental health.
Proper uses of touch truly have the potential to transform the practice of medicine—and they’re cost effective to boot. For example, studies show that touching patients with Alzheimer’s disease can have huge effects on getting them to relax, make emotional connections with others, and reduce their symptoms of depression.
Tiffany Field has found that massage therapy reduces pain in pregnant women and alleviates prenatal depression—in the women and their spouses alike. Research here at UC Berkeley’s School of Public Health has found that getting eye contact and a pat on the back from a doctor may boost survival rates of patients with complex diseases.
http://greatergood.berkeley.edu/article/item/hands_on_research
The person concerned (doctor is this question) must learn the techniques of anger management and developing emotional intelligence (EI). Ofen, when we have a high sense of ego, we tend to retort the other person, whose behaviour we do not approve of. It is recommended that it is a great virtue if we can develop humility and control or lower our ego. This can go a long way in promoting our effectiveness as a professional or as a doctor or as a teacher or as a manager.
I agree with Debi in that the doctor himself must learn the techniques of anger management and developing emotional intelligence.
Precisely speaking, we can minimize or have greater control on our ego and anger by the following:
--Befriending people with a positive'tolerant mindset & interacting with them more often
--Practicing meditation and yoga as a way of living our life
--As part of emotional intelligence, making self regulation as part of our mission
If we go into the reasons behind the anger, we can understand the patient's depression, anxiety, apprehension and insecurity. All these are bound to make the patient fidgety and angry. What we can do is go in his shoes and counsel him, with a calm and quiet attitude.
Sensitive communication skills are crucial if patients’ psychological problems
are to be identified and managed successfully.but are often rudimentary and
largely confined to the treatment of patients who d Liaison psychiatry services are
gradually being developed in general hospitals eliberately self-harm. At a
time when general psychiatry is concentrating on the treatment of chronically ill
patients in the community, it is important to ensure that healthcare
commissioners are aware of the need for a multidisciplinary liaison psychiatry
team in each general hospital
http://www.rcpsych.ac.uk/files/pdfversion/cr108.pdf
The patient never like a doc who gives a serious look to there illness. They are mostly aware and like the feeling of well being.Also in comparison one will find angry patients in private hospitals whrn they are paying hefty bills.So, a doctor needs to choose his environment of work according to his temperament and mindset
A patient should believe a doctor.Highly professional doctor's actions, attention and warm words arouse patient's belief, understanding and willingness to cure.
"There are many situations where physicians may have to deal with patients who are angry. In most cases the most helpful intervention is to look past the anger and attempt to identify, and alleviate, the underlying reason for the anger. Attempting to do this in a busy clinic or hospital setting can be quite difficult and requires both perseverance and practice." Fine reading follow!
http://www.kevinmd.com/blog/2014/04/4-reasons-patients-angry.html
I think angry patient is not a problem but the angry co-patient is the problem
Our mission is to cool them down as much as we can. If not then try to avoid to increase their tension
I belive that anger is a state of mine where there would be a possible cause of it. I would try to find the cause for getting angry and to find its solution. It is not always easy in this regards but i had achieved some sucess with this method.
I would say that love has formidable power. Add to that 'No ego'. It can do wonders. We often show reaction, and that is how the conflict gets enhanced. One thing leads to another, and the incidence of bitterness increases. I am of the view that love and behaviour of reasonableness in argument can be a panacea in tackling such patients.
When a Patient is Angry, try to pause and be attentive, and also avoid being defensive.
In clinical work, we should stay curious about the patient's story.
In general, our talking and behavior should not be a reaction to what the patients talk or behave. We should be calm with angry or nervous patients.
That is why he/she is a patient, that is part of the ailment needs treatment.
Physicians should understand psychology of patient. Patient anger can be removed by knowing the psychology of his/her anger. I agree that patients may have reached full of frustration and giving up any advise to his/her case. However, in some society I read that doctors have been bitten and beaten. I regret to say that but I also I feel sorry and anguish to such immoral behaviorز
Angry patients 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.
(try to pause and be attentive, and also avoid being defensive.
Dear Mahfouz thank you very much very important addition
v
communication skills is another key factor added by Jeanan and totally agree with , we are as physicians should know the communication skills very well this will solve a lot of problems and will build trust with our patients
love and no ego dear Debi thank you for yor valuable addition isupport what you said am of the view that love and behaviour of reasonableness in argument can be a panacea in tackling such patients
Dear researcher,
These type of issues are very important to discuss and to rule out.
Inferiority, angry, fear and dis satisfaction among the patients are a part of the ailments they suffer which are also due to the environmental factors.
To address such type of issues initial counselling by the physician and the pharmacist help them. The eye contact with the patient, the calmness of the physician/pharmacist giving positive responses towards the patient behavior and making him/her comfortable with the environment will definitely help.
I'm a part of 1200 bedded tertiary care teaching hospital where I come across many rural people, and as it is a government sector majority of the patients feel discomfort with the environment and gets anger soon.. we keep understanding the attitudes of the patients through eye contact and responds them with cool facial expressions and soft voice which projects the soft corner of the patient and half work is done. the remaining part is how well we treat and counsel them regarding the drugs.
Recognize the direction of anger Recognizing the difference between internal and external anger is critical to effective management, because internal anger may lead to potentially harmful patient consequences. When the patient directs anger internally because of fear and guilt this can lead to withdrawal, self-neglect, anxiety, depression, or a combination of these.
Engage rather than withdraw from the patient
Rebekah Wang-Cheng,059 Dealing with Anger, 2nd ed , EPERC, Fast Facts Documents,
we should deal with such patents very calmly and try to listen his/her grievance if any and try to be his/her friend and provide assurance!
According to the reason. If he is angry due to his high risk disease, i try to satisfy him & change his mood into patience & hope of cure. If patient became angry due to some in-office sensitive procedure, done in proper manner but it was somewhat painful for him, i satisfy him also. But if the patient is angry without any logic reason & does not respond to medical team advice to be calm, this is rare, i call the security of the hospital to stabilize the policy of the hospital.
Watch the video below for the Universal Upset Patient Protocol!
"Six simple steps that will show you how to deal with upset patients angry patients quickly and easily. The full training handout for this doctor patient communication lesson is below the video frame.
Doctor Patient Communication and the Universal Upset Patient Protocol!"
http://www.youtube.com/watch?v=C1YsNGupQhI
http://www.thehappymd.com/blog/bid/290399/Doctor-Patient-Communication-The-Universal-Upset-Patient-Protocol
Anger is a feeling; it is not “bad?or “good?any more than joy, hurt or fear is “bad?or “good.?It is not feeling anger that causes problems for us; it is what we choose to do when we feel angry that can be either productive or nonproductive. Anger is a difficult feeling because it does not feel good and, generally speaking, is not acceptable in our culture. Unfortunately, what has been confused has been the feeling of anger and the inappropriate expression of it. Anger is almost always a secondary emotion; that is, it occurs after some other feeling occurs. Often we feel anger after we feel afraid or hurt. We feel anger in the face of criticism, but first we probably felt hurt. This is important to understand. The anger functions in response to a threat or some form of injustice; it is used to block off physical or emotional pain.
Bruce Berger, Managing the Angry Patient. US Pharmacist
http://legacy.uspharmacist.com/NewLook/pix/FEA/anger1.JPG
If the patient "blows up," he has lost control and is so irrational he will no longer hear what you say. As in dealing with a child's temper tantrum, your reaction may determine exactly how long the fireworks last.Keep your cool and don't be manipulated by the patient's anger. Never get angry yourself or try to set limits by saying, "Calm down" or "Stop yelling." As the fireworks explode, maintain eye contact with the patient and just listen. Try to understand the event that triggered the angry outburst.
When the person has quieted down, acknowledge his feelings, matching your words to his level of anger. Express regret about the situation, and let the person know you understand. Try to find some point of agreement, perhaps acknowledging that his complaint is a valid one.
Ask for the patient's solution to the problem. Use phrases like, "Can you tell me what you need?" or "Do you have some suggestions on ways to solve this problem?" End the conversation by trying to reach an acceptable arrangement. Offer options by saying, "Here's how we could handle this."
If the patient threatens you physically or you fear for your safety, don't hesitate to contact security or the police. For more immediate assistance, consider establishing a code phrase that indicates when a staffer needs help.
http://www.hpso.com/resources/article/3.jsp
Dear Mohamed,
Dear All,
I am not a medical doctor but I think one should treat situations like that with maximal understanding, calmness and helpfulness. Of course, these virtues are good for nothing it the doctor is not a good specialist and is not able to find an appropriate therapy.
The doctor should try to be cool and calm first and then he should try to understand the reason of that anger. Patience is very much necessary for treating the rough patients.
Dear @Mohamed, I have found the following 'Difficult Patients' in OSCEs:
The Silent or Reticent patient.
The Rambling or Talkative patient.
The Vague patient.
The Angry patient.
The Depressed or Sad patient.
The Denial patient.
The Anxious patient.
Patient with Somatization.
The Dependent and Demanding patient.
The Dramatic or Manipulative patient.
The Long Suffering, Masochistic patient.
The Orderly and Controlled patient.
The Manic, Restless patient.
The Guarded Paranoid patient.
The Superior patient.
Breaking bad news.
Caring for the dying patient.
Conflicted Roles.
Solving Conflicts.
I was not aware of many types of patient's anger!
http://www.oscehome.com/Difficult-OSCEs-Senarios.html
The case of the angry patients is increasingly common in medical practice, especially in hospitals. The causes are many and the percentage of psychiatric patients is very low and, paradoxically, they are those who give less problems. Many problems we have with addicted habitual patients (recently in my town a lady doctor used the assistance of these patients died, because stabbed by a patient in abstinence asking money to buy drugs). Finally, behind the anger of patients, there is an underworld of people living by the phenomenon. They are lawyers who instigate patients to make legal claims for compensation by convincing them that health care and the professional skills of the operators are inadequate to the needs of patients: obviously a good bill for them is safe, compensation for the patient is not at all if negligence or willful misconduct are not demonstrated. Other person that fuel the anger of patients are journalists in search of scoops on medical malpractice. These evidence mean that the patient arrives already biased against those who would treat his sickly. Remedies? First, the patient must feel in the approach with the healthcare a human being and not a number of beds or medical records. Second, the physician should avoid considering a waste of time over a part of the working day to explain to the patient with terminology from man on the street what is his illness, depended on what is, what is being done to deal with it and cure it the best and what should be its expectations. The lack of clarity and the arrogance of doctors often causes anger of patients.
An old therapeutic strategy is still valid: the awareness of what happens in the body, reduces the fear of the unknown and does not increase the magnitude of the suffering of a patient.
Anger becomes a problem when it harms you or people around you. This can depend on whether you express your anger, and how you express it.
When you don’t express your anger, or express it at inappropriate times or in unsafe ways, this is when it can damage your health and your relationships.
http://www.mind.org.uk/information-support/types-of-mental-health-problems/anger/#.VKoXSsl5JXg
leave them until they calm down .. there are many things to do more important than their anger.
easy solution, but might not be an optimal one.
I always treat agressiveness with a strange serene manner. Angry patients, usually bring information that they don't manage to explain in words. Keeping calm towards them, is the best way to get them to verbalize their ailments.
My Psychisatry Professor in Medical School taught me a magical argument, to start a serene dialogue and stop agressive crisis in patients. I slowly tell them the opposite from the expected. «Don't be afraid of me» .
This always works. It worked for me twice, both in hospital, as also another time in my private practice, I was nearly attacked by an agressive patient that had already hit the security on entrance.
Turning the world upside down, makes them stop and think. And then, you can serenely show interest in helping.
This phrase also works miracles with someone that is trying suicide. (don't be afraid of me) - agressive patients and in general agressive human being are usually afraid of the surrounding world.
However, you have reports about failures of these 'pacifier', or: 'show your neck', or: 'offer the other cheek', approaches to angry or openly aggresive patients. Just for legal issues, that in the end are only deterrent, I'd have everything inside a medical office recorded, sound an image, the current memory and camera systems allow it for an affordable cost, and besides showing what happened in a case of agression to the prectitioner, it may help in analyzing the content of what the patients or the people accompanying them showed or told.
Once preserved for an adequate time, the records can be deleted, many places open to the public have warnings about recording systems being active, and about the rights of those filmed.
Some patients attempt a 'power struggle' with the practitioner, this has been specifically addressed. If the patient starts the consultation by asking about the physician's health and connected subjects, trying to put the practitoner in a patient place, you can suspect he or she has a borderline personality disorder, once called 'psychopats' o' anti-social personality' (btw: I won't trust anybody using the term 'social' for any purpose)
CME sites as QuantiaMd, MDLinx, Medscape, prIME have videos about this subject, all free, you just need registering
New CME, hope it's useful
http://www.physicianspractice.com/law-malpractice/how-react-angry-patients?
This is another CME on the subject, it's common that a subject is approached in close times by several purveyors of web CME
http://www.consultantlive.com/article/how-react-angry-patients?GUID=307CE8CD-33DF-4860-856A-2AC475A5E216&XGUID
Many good answers so far, but I would like to highlight two here: Mahfuz Judeh and Maria Pires
Perhaps. There are X different reasons to be angry, each requiring different approaches? E.g. by removing the cause of being angry?
I am not a medical doctor, but I would separate the complaints. I would assure the "impatient" (patient or acompanying person) that complaints other than health complaints will be dealt as soon as the original health complaint is taken care and the terapy is started. I would either guide him or accompany him to solve any administrative complaint later.
The management of clinical aggression is a major safety issue in healthcare that requires considered and thorough risk assessment to prevent harm to the patient, clinicians and others. This requires a thorough understanding of the history of the patient (if available), their background, and understanding of antecedents, behaviours and consequences for the patient and others in the immediate environment.
As clinicians, we have all experienced patients who feel frustrated and angry for a variety of reasons. In some circumstances this can stem from previous negative experiences with health services, not feeling listened to and/or acknowledged/ appreciated., feeling "brushed off" by others as well mental health and physiological causes, family issues. social disadvantage and disability, or dual diagnosis issues. As clinicians we need to be cognisant of the treating patients with respect, empathy and understanding while maintaining a safe and conducive environment.
Diffusion of aggression can often be managed with having an understanding of the patient perspective, patient feeling listened to and supported thorough assessment of medical and non medical conditions, active listening and rapport, It is important to remember that anger can sometimes begin from small causes and it is important to identify any patient issues or concerns early and build a good relationship. This can go along way in building more positive patient-clinician relationships in the future.
Angry nature is nothing but the temperament of human being in a very general way .There are individual who do not have realistic thinking & the way of life.In such situation individual lose their temperament some time for no reason .Such individual should carry out their own introspection should try to get rid of their angry mood.
Angry patient for their examining for such patient creating a disturbance & very often their mental concentration for examining such patient .
This being a psychic behavior of the patient ,Dr while examining the patient should change their mode of examining patient before starting & treating such patient Dr should make the patient comfortable by their choice of behavior some time should ask the nature of their interest such as sport,movies,music,& such other related areas & if the patient becomes comfortable in this line it is likely that Dr examination may carry out smoothly .
This is my personal opinion
You can start by asking the angry person "why are you angry?" He will change his tune a bit or calm down to a lower -energy level, so communication can proceed under less stress.
Perhaps he is under the impression that the doctor prescribed the wrong medication before and he/she didn't get better but got worse.
Dear Michael Issigonis
IN our setting if you ask the patient "why are you angry?" it means some sort of insult
Maybe exploring the cause of anger is much better than direct question
The wrath / anger of patients is also often the result of their powerlessness and helplessness...
This is how to deal with anger, patients should be an important element in the education of future doctors in medical academies, which should recognize a human being in a comprehensive, holistic way.
Thank you Tomasz communication skills should be part of curriculum
Dear Mohamed,
As a clinician,
The clinician should be the first person who is NOT intimidating the patient. It could stem from being highly prejudiced towards the poor, uneducated, handicapped or those with multiple illnesses patient. Treating patients as diseases, numbers and ridiculing or dismissing their sickness as of no significant importance even though it meant losing a potential life or limbs on the patients' perspective. Doctors should not play God by lying about the truth, displaying his/her mental disorders like Narcissistic Personality Disorder (NPD), Sadistic Personality Disorder (SPD) and unnecessary authority for mere simple request like requesting for a medical leave - gloating in incurring wrath and pain to the patient intentionally. Maintain utmost composure and try to understand the issues as to why the patient "exploded" when he/she should not.
As a patient,
He / She should note that the doctor is there to treat you and not to harm you (except some who displayed openly their (NPD), (SPD) and displaced authority. Patient should ask questions and confirms he/she understands the situation before he/she becomes angry over nothing. The patient should listen through about the illnesses that he/she is facing, potential remedy/risks and the what-ifs before he/she could claim that the doctor is refusing to help him/her. Should the patient refuses to listen to the doctor's recommendation, try to get second opinion than to throw the anger onto the poor doctor who is usually trying to heal you - minus the disorders-stricken doctors.
Overcoming anger
DOCTORS/CLINICIANS
- Doctors should adopt anger management attitude
- Professional in dealing with the truth about the worst case scenario
- Not highly prejudiced or labeling the patient for being poor, uneducated, handicapped even with those acquiring multiple illnesses
- Responsible to treat the patient accordingly otherwise refer for second opinion
- Never ridicule patients at any expense
PATIENTS
- Accept the fact that they are sick and need medical help
- The doctor is the best person to help (except the NPDs and SPDs)
- Understand the risks they are facing if they do not follow the doctor's recommendation
- Accept the fact that some illnesses are beyond help
- If unsatisfied, try to get second opinion.
The ward, hospitals or A & E would then be an angry-free area if the aforementioned are adopted by both doctors and patients accordingly.
Best regards - Mariam
I realize this is a very late reply, but I feel that the way we were taught to deal with angry patients while in school was a very interesting take on the matter.
The director of internal medicine sat all the 3rd year medical students down before we began our clinicals and put us through an exercise. We were paired together; one of us was told to play the part of an incredibly irate patient, to shout at the other student, who was playing the part of the doctor. We were instructed to yell and foment at the doctor for 3 straight minutes, without the doctor responding.
At the 2 minute mark, nearly 90% of those playing the part of the irate patient had run out of energy and breath. By the 2.5 minute mark, everyone had stopped yelling. She pointed out that nearly everyone fails to yell or foment by 3 minutes. Her point was, instead of constantly interrupting a patient who is pouring out their frustration or angst at a provider for a perceived injustice, just listen and wait for them to finish. "Interrupting them is like throwing new kindling on to a fire that is slowly dying on its own; if you leave them to vent out their frustration, they may be more receptive at the end of the tirade, allowing you to answer the question or charge after having fully heard their side of the matter."
To be honest, it has worked several times for me just in the short time I have been in the clinical environment. The only instance where it has failed is when I cut the patient off for berating a nurse or beginning a long blue streak of cursing.
Everyone will, hopefully, find a method that works with their personality and patient population, but I think this method works very well across a wide variety of both personalities and patient populations.
Hope that someone finds this helpful, despite the tardy nature of the reply.
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