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Handling the Angry Patient


No matter what field you work in, these tips will help you keep your cool when patients take their frustrations out on you.

Even patients who are normally calm may quickly reach the boiling point when illness threatens their health, mobility, and independence. Pain and fear can lead to increased stress, anxiety, and frustration, which can result in anger and even loss of control. But do you know how to spot your patient's anger early and defuse it?

For guidance, read on. These tips will help you get control of the situation and hopefully reduce the likelihood of legal action down the road.

Look for the signs

There are signs that indicate a patient's emotional state is deteriorating. Look for changes in body language, including a tightened jaw, tense posture, clenched fists, fidgeting, and any other significant change from earlier behavior. A talkative person, for example, may suddenly become quiet.

Observe the patient for additional signs that his temper is rising. Is his voice raised? Is he demanding excessive attention?

If you detect any of these warning signs, you'll need to act fast to help the patient vent his feelings in a productive manner. Start by spending extra time with the patient. Although you might be tempted to spend less time with him, doing so only increases your risk of liability. Ignoring his complaints or, say, rushing him may prove detrimental to his care. And if something goes wrong, dissatisfied patients are more likely to sue.

If, for instance, you work in a healthcare facility, take time to ensure that he is thoroughly familiar with his plan of care and the rationale behind it. Review the care he's received so far, the progress he's made, and how long his recovery should take.

Show empathy

Some patients won't be soothed by your extra attention and may become belligerent, demanding to know such things as, "Why can't you start my therapy now?" "Why isn't my treatment working?" or "Why aren't my medications ready yet?" Your calm approach in answering such obviously loaded questions can prevent anger from turning into a behavioral crisis.

Rather than becoming defensive, you'd be wise to respond calmly to the patient and treat him with respect.

If a patient is uncooperative, try to identify the underlying reason. A patient who balks, for example, when a PT suggests replacing one exercise for low back pain with another may actually be anxious about an upcoming procedure or the results of tests. After you hear him out, reassure him that you take his concerns seriously. Empathize with him, saying something like, "I understand how upsetting this must be for you."

Be sure, however, to calmly explain the consequences of his refusal. In this example, the PT would need to elaborate on the reason for the new exercise and explain that the patient's unwillingness to cooperate will delay his recovery.

If, on the other hand, the problem is an administrative one--such as having to wait too long to see a healthcare provider--speak to the appropriate person about scheduling a time that's less likely to involve a wait.

Keep your cool

If a patient is angry enough to verbally abuse you, remain calm and professional. Keep some distance between you and the patient and do not respond until the verbal barrage is over. When it is, speak softly and call the patient by name. For instance, an EMT confronted by a patient screaming that he doesn't want to be touched should listen quietly until the patient is done. He can then try to soothe the patient, saying something like, "I know you're scared, Mr. Smith, but I just want to take your blood pressure and make sure you're okay." That approach may calm the patient enough to allow for a more thorough examination.

Should a patient become irrational, he's likely to try to intimidate you. He may say things like, "I'm calling my lawyer" or "I'm going to sue."

Trying to justify the situation or defend your actions will only make things worse. Use active listening instead: Paraphrase back to the patient what he's already told you, while at the same time identifying the real feelings behind the words--fear or helplessness, for instance. Keep your statements short and simple. Continue to treat the person with respect and show accepting body language by letting your arms hang loosely at your sides rather than standing with your hands on your hips or with your arms crossed.

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.

Regardless of the extent of the patient's anger, documenting complaints--as well as attempts to resolve them and the results of each intervention--can ward off frivolous claims or help in your defense if a lawsuit proceeds to trial. If applicable to your line of work, note administrative complaints in an incident report. Document clinical complaints in the patient's chart.

Dealing with difficult patients will always be a challenge. But your finesse in defusing and managing anger will keep the focus on getting the patient healthy and protect you from unwarranted legal action.

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