'Problem' Patients: Dealing with Angry, Edgy Patients

This is the last in a four-part series exploring better communications with your patients to enhance their visits to your practice. Scroll down to access earlier parts of this series and be sure to join us on Wed., June 1 at 8 p.m. EST for a Twitter chat with Trisha Torrey.

Perhaps one of the biggest complaints I’ve heard from doctors is that they are seeing an increasing number of angry patients. Appointments are clouded by a tension that used to be rare. It’s difficult to get these patients to open up. Little or no conversation takes place.

“Good to see you today, Mr. Lee. How does your shoulder feel?”

“It still hurts.”

“I’m sorry to hear that. Have you been taking that prescription I wrote for you?”

“Sometimes.”

“Has your therapy helped at all?”

“Therapy was a waste of time.”

Not only can’t you get your patient to open up, but it’s clear that there is something else besides his shoulder pain getting in the way of the conversation.

You’re wondering what Mr. Lee expects from you if he won’t be more helpful. You’re ready to finish up the appointment as quickly as you can and move on. But if you do that, Mr. Lee will just return next time with even more of a chip on his painful shoulder.

What makes Mr. Lee behave this way?

As we’ve highlighted in previous parts of this series, the basis for the anger is history, Mr. Lee’s ability to trust the care he will receive, and your ability to deliver it by managing his expectations. Mr. Lee is refusing to cooperate because for some reason, he feels his trust has been violated.

Trust is built when patients feel respected. Lack of respect creates lack of trust. Maybe Mr. Lee was left too long in the waiting room. Some older patients don’t like the 20-something medical assistant calling them by their first names. Other patients are frustrated because you won’t discuss the information they found on the Internet. Still others have modesty issues and may be embarrassed.

Another reason patients get angry is because their expectations have not been met. Mr. Lee didn’t realize that his last prescription would require two weeks before his shoulder pain began to subside. No one explained he would need to take his pain meds with food or he would suffer nausea. When the nurse took his vitals and he mentioned he had begun eating cherries because he read somewhere that they would ease his pain, she laughed at him. In all cases, Mr. Lee expected one reaction but got another.

There are extremes, too. These descriptions probably don’t fit you, but may describe your colleagues: doctors who are arrogant, or belittle their patients, use words their patients don’t understand, or who are dismissive. Your patient may be angry because he has dealt previously with a colleague who behaves in these ways. Not your fault – but you’re paying the price.

Is there any way to improve Mr. Lee’s disposition and behavior? For most angry patients there is.

The best approach is to be direct - face it head on. When Mr. Lee puts up those seemingly impenetrable walls, pause, look him directly in the eye, and ask him, “Mr. Lee. I sense an unspoken problem here and it strikes me that you are frustrated or angry. What can I do to help?”

Yes, he may clam up, and you may not get any further information. But most patients, when provided with an open door, will walk right through it. They’ll tell you what’s going on.

Know that whatever is bothering one patient is bothering many others as well. If you listen carefully, you’ll know what adjustments will need to be made across the board. He’ll tell you, “I didn’t know that….,” or “You didn’t tell me ….” It may be “You told me…. But it didn’t work.” Or “How was I supposed to know that….”

You may need to hear between the lines of his answers. “I didn’t know…” means he feels like you didn’t explain it to him, and he thinks you should have. “It didn’t work” means he expected it would, and you didn’t help him understand that it might not.

Your tendency may be to defend yourself. For example, you may remember telling him that it would take a few weeks before his pain pills would work. Or you know that it says right on the bottle that the medicine should be taken with food.

The problem is, even if you are right, your patient’s perception is that you are wrong - and that’s why he is angry. You are the professional, and you are responsible for making Mr. Lee feel better about it.

What is required here is good, solid, memorable communication. If he complains about the waiting room - look into the delays. If he is embarrassed or feels disrespected, figure out why and make adjustments. When your patient describes something to you, relate his story back to him, telling him you want to be sure you understand. When you give him instructions, ask him to repeat them back in his own words. Be sure you manage his expectations by describing the benefits of adherence, or the consequences of bad choices. Be clear about side-effects and which ones require immediate follow up.

A good relationship with your patient is like a good marriage. It requires that solid, useful, fair, two-way conversation. When you respect your patients, and model good communication, you’ll find their demeanors improve - a benefit to everyone.

Trisha Torrey is "Every Patient’s Advocate," the About.com Guide to Patient Empowerment, and author of "You Bet Your Life! The 10 Mistakes Every Patient Makes (How to Fix Them to Get the Health Care You Deserve)." She focuses on helping patients and doctors work more collaboratively to improve outcomes for all.