“They should also remember that the threshold for aggression may be lower than normal when a patient or their accompanying relatives are frightened, in pain or anxious.”
Explore This IssueApril 2013
Once the cause of a patient’s anger is determined and deemed legitimate and the threat of violence has been avoided, the next important step is to listen to the patient with empathy, said Dr. Harkins. Tell the patient that you understand that he or she is upset about a situation, but that the response is improper.
“When a patient’s response to anger is out of line, I will speak to them directly,” Dr. Harkins explained. “Most of the time, once you tell the patient that they can’t cross that line, they’ll back down quickly.”
Monica Harris-Broome, MD, director of the communication skills program at the University of Miami School of Medicine, said that when dealing with angry patients, it’s important to listen—not just to the patient’s needs, but also to his or her underlying issues or concerns and unexpressed expectations. She has lectured extensively on the angry patient encounter, or APE, an acronym that she also uses to describe how to defuse a heated situation:
A = Agree: Find something to agree on with the patient.
P = Pause: Time helps defuse heated situations.
E = Emotions: Acknowledge the patient’s emotion, but avoid labeling him or her as “angry.”
Sometimes, however, there is nothing that you or your staff can do to calm down an angry patient. “These patients may have a pathological diagnosis,” Dr. Harkins said, and in these situations, security may have to be called. “This is rare, but it does happen.”
What Not To Do
The No. 1 rule when dealing with an upset patient is to not fan the flames of anger, said Dr. Bown. “Try not to escalate the situation by remaining calm rather than ‘matching’ the patient’s behavior,” she said. Dr. Harkins agreed: “There are two rules I follow when dealing with angry patients: I don’t ever raise my anger level, and I never swear.” He said that if you respond to anger in kind, you’re just creating a really bad situation that can quickly spiral out of control. Additionally, it’s essential to set an example, said Dr. Harris-Broome. “Don’t ask a patient to calm down; model calmness,” she said.
Back Up Staff
Another point to keep in mind is that it’s extremely important to support your front office staff. “They’re the ones who are usually being abused,” said Dr. Harkins, explaining that often they are on the front lines and experience the brunt of a patient’s frustration. “If you don’t back them up, they’ll feel insecure in the workplace and may leave,” he added.