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How to handle an angry patient

In a medical practice, an angry patient – and sometimes a really angry patient – is apt to appear any time.

In a business such as a fast food restaurant, anger is minimal, because the customers don’t have high expectations to begin with, says Bob Rose, PhD, of the Rose Porterfield Group, a Dallas business consulting and industrial psychology organization.

But when it comes to medicine, “people are passionate” about their expectations, he says. The services they get affect their lives, and as a consequence, handling anger and high emotion is part of the manager’s job.

Here’s how to handle the angry patient, and possibly stave off a malpractice claim.

Take that venomous call

When the receptionist says “Patient Smith is calling and he’s really angry,” take the call.

Any manager’s first reaction is to say “tell him I’m not in,” and call back a few hours later, hoping Smith will have calmed down by then. But the brushoff only exacerbates the situation. Now the caller is angry about two things – the original problem and getting ignored.

Deal with Angry Patient Smith immediately, Rose says. Don’t dodge the confrontation. The real reason he’s calling is to solve a problem, and when there’s no response, he loses faith in the manager as well as the doctor’s skills.

Beg off for 10 minutes

Time can cool that caller off, however. About 10 minutes is enough, and there’s an easy way to buy it.

Take the call, but maintain a pleasant tone and say “I understand you’re upset, and I apologize for that. I need to look at your record (or appointment book or specialist referral or whatever) to give you a full answer. If you can give me 10 minutes to get it, I’ll call you right back.”

The 10-minute request is believable, because anybody knows it takes a little time to locate papers. It’s also flattering, because the manager (or physician) is stopping everything to deal with the patient’s problem.

The little delay does two good things. It gives the patient time to cool down, and it tells the patient the manager is concerned about the issue and is trying to find a solution.

Thus, by call-back time, the manager has moved from a defensive posture to a proactive one. Now instead of an argument, there’s a conversation where “we are both working together to solve a problem” – and the manager is in control of it.

Find something to apologize for

Neutralize the anger further with an apology.

That doesn’t mean the manager has to admit to any wrongdoing. It means instead that the manager has to be sympathetic to the patient’s feelings and find something to apologize for, even if it’s no more than the patient’s frustration.

An apology gives an angry person a graceful way to back down, Rose says.

Suppose the doctor told Patient Smith last Friday that test results wouldn’t be in until Wednesday. Smith forgets, calls Tuesday for the results, and gets angry that they aren’t available.

It’s easy to respond to that with “I told you last week the results wouldn’t be back until Wednesday.” But it’s not going to resolve the issue. It’s only going to embarrass the patient and spur on the anger.

Stay calm. Be sympathetic. And come up with something to apologize about: “I’m sorry. I know you must be frantic to get those results. You may not remember, but I told you last week that it would be Wednesday before we could hear anything. I apologize if I didn’t make that clear.”

On the other hand, he says, if the patient is right, take responsibility for being wrong. When somebody is angry and rightfully so, ‘fess up to it, says Rose.

The patient may not be pleased, but the alternative is worse. When somebody denies an obvious mistake or broken responsibility, the anger can reach the boiling point – and a malpractice suit.

Sidling up to the patient

When the angry patient is in the office, just a change in the seating can often stop the fray.

Suppose there’s a disagreement about a bill. More than likely, manager and patient “are sitting across the desk from each other,” Rose says. They’re also glaring at each other.

Instead of getting into a staring contest, walk around, pull up a chair next to the patient, and sit down to discuss the situation.

Sitting side by side does just what the words say – it puts both persons on the same side. It quells the emotion. Now the two are on the same page trying to solve the same problem.

He cites a time in his own office when a client who was sitting across from him got angry to the point of pounding his fist on the table. Rose walked around the table, sat down in the chair next to the man, and said “what needs to happen here? What do we need to do to solve this problem?”

The goal at that point is to find out exactly what that other person is upset about and figure out a way to take care of it.

The rule of two e-mails

Anger often comes from communication errors, Rose says. And the place where communication most easily falters is email.

When somebody calls and says “I didn’t get X from you,” the other person can voice “what?” in a way that shows genuine concern. But in an e-mail, that’s likely to be written as “WHAT???” and the other person may well read it as a rude “you’re wrong” answer. And the fight is on.

To keep emails civil, follow “the two-email rule.” When someone expresses even a minor concern in an email, respond no more than twice. If the matter isn’t resolved at that point, it’s time to stop writing and start talking.

Send a final email of “we’re getting off on a wrong tangent here. I think we need to stop emailing about this and arrange a time to talk.”

Two more points about anger

Rose adds two more elements about managing a patient’s anger.

First, rarely is somebody’s anger caused by a single issue. Almost always, it’s been building up over a number of issues, and what the patient mentions is just the tip of the iceberg.

Any display of anger is a sure indication that the patient is and has been dissatisfied with a lot of things for a long time.

And second, there’s a good side to getting a call from an angry patient. Somebody who says “I didn’t like the way you did this” was angry before making the call. Take that statement as a fire alarm: the bad news is that there’s a fire; the good news is that now the manager knows about it and can put it out.

Far more damaging is the patient who seethes in silence and then just doesn’t pay the bill – and maybe calls an attorney.

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