How to Handle Difficult Patients and De-Escalate Tense Situations


Empathy, listening, and education can help

Tense situations and difficult doctor-patient encounters are, unfortunately, not uncommon in health care settings. When patients who are afraid or frustrated interact with medical providers who are tired, overworked, or burned out, the outcome can be unpleasant—and can even lead to malpractice lawsuits or violence. It’s imperative that doctors and staff learn to manage common situations that can arise in any practice. Here are a few examples, from mild to serious, that can frequently occur between doctors and patients.

The Disgruntled Patient. Despite doctors’ best efforts to stay on schedule, things come up and emergencies happen. At some point, it’s inevitable that a patient who has had to wait will express frustration or anger. The patient may be in pain, late for work, and feeling as though you don’t respect their time. Before you react, take a moment to check your own feelings, advise Sharon K. Hull, M.D., MPH, and Karen Broquet, M.D. in Family Practice Management.

“Your own sense of being harried and running late may trigger an angry reaction from you, but simply taking a deep breath and offering a sincere apology would be a more constructive response.” The authors suggest saying something like, “I can understand why you are upset, and I appreciate your waiting for me” to ease the patient’s frustration.

For more on this topic, see Do’s and Don’ts for Effective Doctor-Patient Communication

The ‘Drug-Seeking’ Patient. Given that the U.S. is in the midst of an opioid epidemic, pain management is a controversial topic for both patients and doctors. Doctors may encounter patients who come in asking for specific drugs. Wary of overprescribing, they may react with suspicion or by minimizing the patients’ pain. A better reaction is empathy and really listening to the patient. Rather than perceiving them as pushy or drug-seeking, consider that they could be giving you important information about their medical history. Of course, if you suspect the patient is not being forthcoming or is not adhering to treatment plans, there may be another issue at hand.

This also applies to patients who come in asking for antibiotics. Take the time to discuss why antibiotics are not always necessary, and explain why you are or are not prescribing them the medication they are requesting.

For more on this topic, see Why Successful Pain Management Requires Trust

The Angry Parent. Any doctor who works with pediatric patients has likely encountered a parent who is fearful, sleep-deprived, and emotional, and taking it out on you. Pediatric hospitalist Jessica Lloyd, M.D. says empathy and strong communication skills are important in these situations. “Doctors have to remember that when parents voice frustration, it’s because they’re worried and scared. If a parent is angry, pediatricians must take a step back … and not take it personally.”

For more on this topic, see When Parents Google Their Kids’ Symptoms

There are many reasons patients may be ‘difficult’; they may be in pain, tired, scared, affected by drugs or dementia, or have literacy issues, to name a few.

Consider that there may be reasons for other types of “difficult” patients and encounters. Drugs, alcohol, or dementia could be factors, noted Nursing Times. The overly friendly or intrusive patient may be lonely, a non-adherent patient may have literacy issues or cultural differences, and an anxious person may require more patient education than others.

For more on this topic, see How to Manage Unique Patient Personalities

Best practices for empathetic listening

Did you notice a common theme in the suggested responses above? That’s right: empathy. It is consistently among the top qualities patients say they want from their doctors. And, it may be the key to defusing that difficult patient interaction.

Techniques for defusing conflict include empathetic listening and the LOWLINE model, which involves asking open-ended questions like “Can you tell me more about that?”

“Listening to the individual with empathy is a primary skill in moving a tense situation to a better place,” according to a report titled “De-escalating Conflict in the Healthcare Setting,” by Dr. Marge Paccione. She breaks down empathetic listening into these components:

  •     Give your undivided attention
  •     Validate feelings
  •     Tolerate silences
  •     Be accepting and nonjudgmental
  •     Reflect the communication

In practice, this looks like facing the patient, making eye contact, and saying things like, “I hear you” and “That sounds frustrating.” Dr. Paccione writes, “Crisis resolves one small step at a time. If your intervention brings some calm, you are on the right path.”

Nursing Times describes a similar but more robust model for effective listening: the LOWLINE approach to de-escalating anger, which stands for Listen, Offer, Wait, Look, Incline, Nod, Express. This model recommends using open-ended questions such as “Can you tell me more about that?”; “What happened after that?”; and “Do you have other thoughts and feelings about that?” These types of questions “can help the patient explore the cause of the anger and possible solutions,” according to the article. “Anything that causes the patient to explain, rather than argue, would help lower the confrontation level.”

Focus on factors you can control

It’s also important to recognize that while you can’t control every patient encounter, there are things you can control, starting with yourself. “Not all difficult encounters can be blamed on the patient side of the interaction,” wrote doctors Hull and Broquet. “Physician attitudes about care, fatigue, stress, and burnout can create circumstances in which physicians are responsible for the difficulties.” If you suspect that may be the case for you, read Stress Management for Doctors for helpful tips.

Doctors often overlook the role of their own attitudes and environmental factors that contribute to difficult patient encounters.

The authors also note that doctors often overlook the fact that their surroundings can contribute to a difficult patient encounter. “If the environment is noisy, chaotic, or doesn’t afford appropriate privacy, patients, providers, and staff are all more likely to be unhappy or unpleasant. These factors can often be alleviated with a bit of forethought.” Is your waiting room a pleasant place for patients to spend time? Are you feeling pressed for time? Using a service like Rendia allows you to passively educate patients while they wait, making better use of both your time and theirs.

Often, an anxious patient is one who could benefit from additional education to better understand their treatment options. Frustrated patients want to know that their doctor cares about them. Showing them narrated animations like Rendia’s has been proven to increase patients’ perceived quality of care.

Want more suggestions for improving your patient encounters?  Get in touch with us today to schedule a demo!

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