How I manage encounters with angry patients

Fortunately, in most medical practices, angry patients are the exceptions and not the norm. When dealing with the wrathful few, however, I have found that the transiency of my clinical fellowship position often makes me the most suitable buffer. Thus, I sometimes find myself at the front lines of livid engagements. Over time, I have acquired some humble insights on interacting with angry patients that may be helpful to you.

Patients become angry for a multitude of reasons: rude receptionists, long waiting times, hunger/thirst, unmet expectations, or a combination of factors. Regardless of the reason for the anger, when I enter the examination room with a well-practiced smile, the surprise of finding a cold shoulder and simmering stares can be quite unsettling. To discipline myself emotionally and turn a potentially hostile encounter into a productive one, I rely on a simple strategy, the five As of anger deflection: allow, absorb, assess, acknowledge, and absolve.

In your mind, categorize the complaints broadly to help you address them later. This detached, intellectual exercise isolates your professional judgment from the emotional ripples.

If the patient simply is irritated, decompression by uninterrupted venting can quickly dampen the harsh tone of the encounter and sometimes can prevent an escalation and outburst. On the other hand, if an outburst is imminent, allowing it occur without intrusion can limit its scope and damage. In the rare instances when the outburst shows no sign of resolution and is accompanied by disruptive or threatening behaviors, terminate the encounter.

2. Absorb. After the patient's outpouring, absorb the experience with a moment of silence. This maneuver is the most important one during an angry encounter, and it also is the simplest.

During this inflamed stage, any words from the you will sound either antagonistic or defensive to the patient. Therefore, resist the urge to reply.

While maintaining eye contact with the patient, let the imaginary echoes linger, and allow the air to stiffen. Deflect any follow-up probing by stating, "I am trying to absorb everything you have just said."

Soon, the atmosphere will thicken to an icy near-awkwardness. Without rebuttal from you, the patient is deprived of ammunition to engage and escalate his or her behavior, and a confrontation is thwarted. This moment of contemplation not only allows you to settle mentally; it also allows the patient moments of introspection, which may catalyze the early consequences of remorse. By not speaking, you gain moral high ground.