It’s not often I aim my blog posts toward doctors and providers, but this follow up post to Hell of the Angry Patient is just that; a follow up with ideas for doctors who find themselves and their staffs confronted with an angry patient.
Forgive the regurgitation of some of the earlier post, but I want to be sure you understand it…
The point was that patients, or the loved ones of patients, who have suffered at the hand of healthcare through medical errors, failure to diagnose, misdiagnosis, or even through their own perception, may be angry, and they may transfer that anger to any other doctor or provider. Because of the nature of healthcare, patients have no choice but to return to the very system that caused the problems to begin with. It’s no wonder they are angry!
The post goes on to give patients some ideas for overcoming their anger and even moving on toward forgiveness.
Many providers just don’t get it. I had that experience myself. After my misdiagnosis was confirmed, I knew I still had to figure out just what had caused the lump to grow on my torso. If it wasn’t cancer, then what was it? So I made an appointment with my dermatologist. The earliest one I could get was almost two months later…. so by then not only was I still angry at the misdiagnosis experience, but I was frustrated with waiting so long to get some REAL answers.
The dermatologist, Dr. D, is very highly respected and I had been to see her twice previously. But she was a perfect example of how NOT to work with an angry patient. Based on that experience, subsequent experiences, and conversations with hundreds of patients and doctors since then, I make these suggestions to providers for improving that scenario:
Begin by assessing the root of the anger, or even whether anger IS the root. Your patient may or may not say anything about it…. but body language will give it away. You can ask the same basic questions you always ask to make that assessment. If the anger seems to stem from anything at all related to a previous experience with healthcare, then it’s up to you to begin helping that patient get beyond it.
Once you determine your patient is angry or frustrated by whatever is going on with his or her health and previous care, ACKNOWLEDGE it. “I can see you are angry” or “I can see you are frustrated.” Then explain the reality, “I don’t want to spend all our time today talking about previous problems, but if you can tell me briefly why you are angry, it might help us understand what to do next.”
Then LISTEN. Don’t interrupt, unless you need to ask the patient to be more concise. Yes, I realize it will eat into the allotted appointment time, but I can almost guarantee that it will be much more efficient, and the outcomes will be much more successful, if you can just be patient (so to speak) and hear your patient out.
Why? Because the patient has put up a wall between him/herself and the medical system based on the previous experience. There’s a good chance that wall, that shield, will cause further problems. The angry patient won’t hear YOU through her anger. You will further frustrate her, because just like her previous violating provider, you aren’t listening in order to improve her health either.
If you don’t listen, you will become a target for his/her anger, too. Not necessarily because you deserve to, but because you will be repeating the very behavior s/he experienced with the doctor who already caused the problems that made him/her angry.
Jerome Groopman, well-regarded physician and author of How Doctors Think, cites a study in which doctors interrupted their patients, on average, within 18 seconds of asking the question, “Why are you here today?” Can you imagine that happening to you? What if your spouse or your children interrupted you within 18 seconds of explaining a problem? What if your auto mechanic did that? What if your child’s teacher did that? Wouldn’t it frustrate you too?
So yes — acknowledge the anger, then listen to what caused it, then proceed to the problem at hand by LISTENING again. You will find your communication with that patient to be so much stronger, you will find that patient listening carefully to you! And you will find that patient complying with your recommendations and next steps far better than the patient would have if you were still being perceived as part of “them” — those who caused the problem to begin with.
Listening builds trust. And any patient who has been violated by the system has lost his/her trust. As the next doctor or provider she sees, you need to begin building that trust again, not degrading it further.
Patients — if you’ve read this far — consider working with your providers to teach them how to listen. Strengthening that relationship between doctors and patients depends on acknowledgement and listening. And that means from both sides of the doctor-patient relationship.
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