Saturday, October 22, 2005

Dr. Bernstein, on "The Angry Patient"

The angry patient is a like a thorn suddenly
Pricking the finger of the unwary doctor
But, perhaps, sticking there with great pain and consternation
The doctor trying some way to pull it out
And not push it in deeper
Dr. Maurice Bernstein cites a list of suggestions to help defuse angry encounters. I've met countless angry patients, and I heartily agree with these techniques. My personal favorite: listening. The angrier the patient, the more I try to stop, and hear, and understand.

Here's ACP Online, on "working with tough patients:"
When faced with an angry patient, for example, start talking about patients' emotions at the very beginning of the interview.

"Go for the elephant in the room, which is the looming emotion," Dr. Fortin said. Acknowledge patients' feelings, and apologize for any factors—like long waiting times—that might be tied to you. "At the same time, don't make excuses," he added. "Your goal is to calm them and to try to find common ground."

Be aware that anger often masks fear, particularly in male patients. In one role-playing session, panelist Robert C. Smith, FACP, professor of medicine at Michigan State University, pretended to be an irate patient who initially found fault with every aspect of the office visit. That gruffness faded, however, as the interviewing physician focused on getting the patient to talk about his emotions. The patient eventually admitted how frightened he felt that his chest pain might lead to surgeons cracking open his chest.

While physicians can defuse most encounters with angry patients, there are times when you have to set boundaries, Dr. Dwamena pointed out. If patients become disrespectful or threatening, leave the room.
Dr. Maurice invites comments from doctors and patients...


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