Dealing with angry patients and family members
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Angry patients can evoke fight or flight responses in medical professionals. Inability to diffuse situation in a professional manner can lead to disastrous consequences. Here are few tips to effectively diffuse the situation
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Dealing with angry patients and family members
- 1. Dealing with angry patients & family members Dr. Padma Puppala
- 2. Anger often is either an expression of emotion derived from the patient’s situation and/or triggered by minor lapse, often unrelated
- 4. Getting caught in an altercation with one patient or a family member can interfere with your effectiveness as a clinician and compromise care of other patients too
- 6. When any patient appears to be “angry,” the presence of pain must be considered and treated as a matter of urgency
- 7. Hospitalization can be an intensely destabilizing experience for both the patient and his or her caregivers ; “Physical, emotional & Financial”
- 8. Patient’s sometimes feel their requests are unheard, expectations are not met or they are not informed about their condition, plan of management or risks involved
- 9. Calm, professional and empathetic approach is essential for establishing coherent dialogue and diffusing the situation
- 10. Anger is contagious It can trigger fight or flight response in you
- 11. How we react….. Try to solve the problem Defend yourself or the person who upset them
- 13. Universal upset person protocol Dr. Dike Drummond “Works for patients, colleagues, your partner, children and even complete strangers” Regardless of what/who they are upset with, Either verbally upset or visibly upset, but silent
- 14. 6 Steps of UUPP You look upset Tell me about it I’m so sorry this is happening What would you like me to help Here is what we can do
- 15. Acknowledge the emotion and encourage to speak and vent it out
- 16. An angry patient is unlikely to be receptive to your explanation until his grief is fully expressed
- 17. The patients' stories need to be heard. Careful listening is just a part of defusing the patient's anger
- 18. Active-listening involves repetitions, summaries, validations, and empathetic statements
- 19. Our curiosity about what has happened has a therapeutic effect. By staying curious, we also avoid being defensive about ourselves.
- 20. By arguing, trying to judge or expressing opinions, a power struggle may ensue making things worse
- 22. As clinicians, we usually do not know the details of what has happened, and we often cannot and need not resolve the problems
- 23. Whatever the cause of anger may be, empathy can still be used to address the patient's emotions
- 25. Unfortunately difficult patients continue to exist. You can’t beat them or throw them out
- 26. The term “difficult” is subjective. Differences in expertise and experience account for differences in perception
- 29. Summary • Errors in hospitals would continue to happen • Sometimes, due to loopholes in processes • Face it; Don’t run away • Avoid being defensive or blaming people • Acknowledge patient’s emotion, empathize • Establish trust and diffuse situation • Learn from experiences by introspection
Editor's Notes
- Why do patients become angry? What are the common “root” causes? 1. Pain. Medical illness is often accompanied by pain, so much so that pain is often considered the fifth vital sign. Assessment and treatment of pain is an important factor for all medically ill patients. Anger is a common emotion in patients with pain, especially chronic pain. It is thought that the presence of significant anger may in fact further aggravate the feeling of pain. Physicians must not only be able to assess pain, but also to weigh the benefits and the risks in prescribing analgesics. When any patient appears to be “angry,” the presence of pain, especially untreated/undertreated pain, must be considered and rectified as a matter of urgency. 2. Fear and worry. Being medically ill, especially if one is hospitalized, can be an intensely destabilizing experience for both the patient and his or her caregivers. In some cases, an unknown prognosis, the occurrence of complications or the impact of the illness on their independence, can make patients fearful about the future. This worry can manifest as anger, and since patients cannot direct their worry or anger toward their illness, this anger may be displaced onto people around them, including hospital workers. Attempting to recognize, and where possible alleviate, their worries is often very helpful. 3. Feeling unheard or uninvolved . Any patient who displays anger in a hospital setting is guaranteed to attract attention. For some patients the expression of anger may actually suggest that they feel “unheard” in the medical setting. They may feel that they do not have enough information about their condition or their concerns have not been addressed. The question then arises, how do we make them feel heard? Do they understand why they are in the hospital? Do they understand what their treatment options are? Do they feel they have been part of the decision-making process? Ensuring that patients feel they are involved in their care can reduce the anger that can arise out of being “unheard” in a hospital. 4. An unidentified medical condition or psychiatric disorder. Some individuals may become very angry or irritable in the context of a medical or psychiatric problem. Withdrawal from an addictive substance such as heroin or the presence of major depression or delirium can present with irritability or agitation. It is important to ensure that patients who present with anger are evaluated for the presence of an underlying psychiatric or medical condition.
- Why do patients become angry? What are the common “root” causes? 1. Pain. Medical illness is often accompanied by pain, so much so that pain is often considered the fifth vital sign. Assessment and treatment of pain is an important factor for all medically ill patients. Anger is a common emotion in patients with pain, especially chronic pain. It is thought that the presence of significant anger may in fact further aggravate the feeling of pain. Physicians must not only be able to assess pain, but also to weigh the benefits and the risks in prescribing analgesics. When any patient appears to be “angry,” the presence of pain, especially untreated/undertreated pain, must be considered and rectified as a matter of urgency. 2. Fear and worry. Being medically ill, especially if one is hospitalized, can be an intensely destabilizing experience for both the patient and his or her caregivers. In some cases, an unknown prognosis, the occurrence of complications or the impact of the illness on their independence, can make patients fearful about the future. This worry can manifest as anger, and since patients cannot direct their worry or anger toward their illness, this anger may be displaced onto people around them, including hospital workers. Attempting to recognize, and where possible alleviate, their worries is often very helpful. 3. Feeling unheard or uninvolved . Any patient who displays anger in a hospital setting is guaranteed to attract attention. For some patients the expression of anger may actually suggest that they feel “unheard” in the medical setting. They may feel that they do not have enough information about their condition or their concerns have not been addressed. The question then arises, how do we make them feel heard? Do they understand why they are in the hospital? Do they understand what their treatment options are? Do they feel they have been part of the decision-making process? Ensuring that patients feel they are involved in their care can reduce the anger that can arise out of being “unheard” in a hospital. 4. An unidentified medical condition or psychiatric disorder. Some individuals may become very angry or irritable in the context of a medical or psychiatric problem. Withdrawal from an addictive substance such as heroin or the presence of major depression or delirium can present with irritability or agitation. It is important to ensure that patients who present with anger are evaluated for the presence of an underlying psychiatric or medical condition.
- Interpersonal in nature Difficulty in dealing is a function of the relationship Based upon discomfort with What has happened What might happen
- The #priority at this stage is to resolve the issues as early as possible. Accepting mistakes and working on solutions without delay Individuals should learn from these mistakes and take up finding a solution as a challenge. Preparations to avoid such mistakes in the future should be given priority and repetitive annoying problems should be avoided. This way the processes are updated and people have an added responsibility to acquire this as a part of their skill set. there should be prioritisation of activities there should also be a contingency plan ready, so that in case of emergencies backup plans can be executed to avoid further damage which is caused by the human errors. If such plans are followed, it minimised the risk and also gives stability to the process execution. However, giving this priority to solve the problem shouldn't lead to neglecting other parallel tasks and activities. The other independent processes should not be halted when individuals are finding solutions to the problems. Infact, the challenge lies in solving the issues without disrupting the functioning of other processes "A Good day means everything is fine.. sssss Bad day means you've gained some new experience and have to fight the challenge"