You,
as a doctor, are a man or woman of science. Reason may
have got you all the way through med school but your logical
mind doesn't necessarily prepare you for dealing with
irrational, out-of-control patients. For many physicians
the worst thing about these trouble-makers is that they
tend not to test your medical skill and knowledge very
much at all — but rather, they try your patience,
push your most tender buttons and waste your time. It
can seem like they're battering rams threatening to take
down your professional demeanour. These cruel convalescents
have a way of making you wish you'd chosen another field
— like tiger dentistry or bee grooming.
But a physician who is a true master
of dealing with angry patients can deflect negativitywith
the finess of a black belt in interpersonal relations.
The secret of these docs' success is unflappable resolve
and an insistence on claiming the moral high ground.
As ancient Chinese military strategist and author of
The Art of War Sun Tzu said about 2,500 years
ago, "supreme excellence consists in breaking the enemy's
resistance without fighting."
WHAT
NOT TO DO
When you first realize you've got an angry patient on
your hands it's critically important that you don't
"talk down" to them or act aloof. If you do slip up
and insinuate the patient is a know-nothing crybaby
then you're just resorting to paternalism. On the other
hand, it's even worse when you allow the patient to
bully you into agreeing with them or giving them a drug
or treatment they want but you don't feel is appropriate.
One of the very worst things you can do to deal with
an irate patient is to accept blame needlessly. Saying,
"I'm sorry" when you didn't do anything wrong may simmer
a patient down for a while, but it will also erode their
trust in your skill and knowledge as a doctor.
WHY
SO UPSET?
To be truly prepared for a difficult patient, you're
really going to want to make enough time to know their
story. If you get a tip from a colleague that the patient
you're to see is a real handful, take the time to bone
up on their medical history. Many of the most difficult
patients you'll face fall into one or more of the following
categories: malingerers, somatization disorder sufferers,
people with a history of noncompliance, and know-it-all
Google-addicted wannabe MDs with a history of challenging
diagnoses. The better you understand where these people
are coming from the less likely it is that you'll lose
your cool and take things personally.
WHAT
IS ANGER?
Knowing your patient's story is half the battle, but
it's also helpful to know a bit about the specific type
of anger that's driving a difficult patient.
"Defusing the Angry Patient" in
last October's issue of the journal OBG Management
talked of the "four faces of anger." First off, there's
the positive sort of anger that we might call righteous
indignation but the hundred-dollar name for it is "primary
adaptive response." This is the sort of anger that prompts
people to demand answers for what they perceive as a
wrong — things like an obviously careless botched
blood-draw that led to nerve damage. You can't really
fault a patient for being angry in such cases.
"Primary maladaptive" anger is
the sort you face when an enraged patient spews verbal
vitriol reflexively. You see this "I'm mad as hell and
I'm not going to take it anymore" type of anger driving
a patient to demand to see a doctor straight away even
when there's a long queue in the waiting room.
"Instrument" anger is subtly different
from "primary maladaptive" in that it can be put on.
Some shameless patients won't hesitate to act like complete
jerks in order to manipulate caregivers into offering
them special treatment.
Finally there's "secondary emotion"
anger. This is the toughest anger to deal with because
it's really just a case of the patient distracting him
or herself from a real emotion that lies beneath the
surface, like the profound fear of dying that follows
a cancer diagnosis.
DEFUSING
THE BOMB
In a way, giving an angry patient more of your time
seems like the wrong thing to do — it's a truly
irksome feeling giving the squeaky wheel the grease,
especially when you don't feel you have enough time
for your thoughtful and cordial patients — however,
nothing beats scheduling a one-on-one meeting with a
malcontent to help patch up a damaged doctor-patient
relationship. And don't procrastinate if you plan on
setting up such a meeting. Sure their anger might dissipate
if you wait, but there's also a good chance the patient
will complain about you to his or her friends and family,
needlessly dragging your name through the mud.
COVER
YOUR REAR
Conflict with patients is one of those things with an
enormous potential to snowball out of control. An angry
patient might have a whole slew of belligerent relatives
ready to flood your facility with complaints. That's
why extra-diligent record keeping is a must when dealing
with these people. Imagine an angry, intractable patient
who refuses treatment. You believe him to be sound of
mind. If he were to take a turn for the worse, detailed
documentation on his refusing treatment might come in
handy.
BE
FAIR, BE FIRM
Even if they have a valid point or two, an unruly patient
has no right to get personal with you. Even if you're
not particularly thin-skinned, don't be a hero. You
shouldn't feel obliged to keep seeing an unruly patient
who obviously doesn't respect your professional opinion.
If you feel the doctor-patient relationship is poisoned,
notify the patient and then turn care over to another
physician.
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PATIENTS & PRACTICE
