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Dealing with angry patients and family members
The document discusses how to effectively handle anger in patients and their families, highlighting that anger can stem from pain, unmet expectations, or feelings of being unheard. It emphasizes the importance of empathy, active listening, and a calm, professional approach to diffusing situations and establishing trust. The author outlines a universal upset person protocol to acknowledge emotions, encourage expression, and promote therapeutic dialogue, while also addressing the inevitability of difficult patients in healthcare settings.
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Discusses causes of patient anger, impact on care, and the importance of empathy in management.
Introduces Universal Upset Person Protocol (UUPP) steps for effectively addressing patient anger.
Emphasizes listening and empathy, avoiding defensiveness, and recognizing emotions to diffuse anger.
Acknowledges the reality of difficult patients, the subjectivity of 'difficult', and the necessity of empathy.
Summarizes key points on handling errors, patient emotions, establishing trust, and learning from experiences.
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Dealing with angry patients and family members
- 1. Dealing with angrypatients & family members Dr. Padma Puppala
- 2. Anger often iseither an expression of emotion derived from the patient’s situation and/or triggered by minor lapse, often unrelated
- 3.
- 4. Getting caught inan altercation with one patient or a family member can interfere with your effectiveness as a clinician and compromise care of other patients too
- 5.
- 6. When any patientappears to be “angry,” the presence of pain must be considered and treated as a matter of urgency
- 7. Hospitalization can bean intensely destabilizing experience for both the patient and his or her caregivers ; “Physical, emotional & Financial”
- 8. Patient’s sometimes feeltheir requests are unheard, expectations are not met or they are not informed about their condition, plan of management or risks involved
- 9. Calm, professional andempathetic approach is essential for establishing coherent dialogue and diffusing the situation
- 10. Anger is contagious Itcan trigger fight or flight response in you
- 11. How we react….. Tryto solve the problem Defend yourself or the person who upset them
- 13. Universal upset personprotocol Dr. Dike Drummond “Works for patients, colleagues, your partner, children and even complete strangers” Regardless of what/who they are upset with, Either verbally upset or visibly upset, but silent
- 14. 6 Steps ofUUPP You look upset Tell me about it I’m so sorry this is happening What would you like me to help Here is what we can do
- 15. Acknowledge the emotionand encourage to speak and vent it out
- 16. An angry patientis unlikely to be receptive to your explanation until his grief is fully expressed
- 17. The patients' storiesneed to be heard. Careful listening is just a part of defusing the patient's anger
- 18. Active-listening involves repetitions,summaries, validations, and empathetic statements
- 19. Our curiosity aboutwhat has happened has a therapeutic effect. By staying curious, we also avoid being defensive about ourselves.
- 20. By arguing, tryingto judge or expressing opinions, a power struggle may ensue making things worse
- 21.
- 22. As clinicians, weusually do not know the details of what has happened, and we often cannot and need not resolve the problems
- 23. Whatever the causeof anger may be, empathy can still be used to address the patient's emotions
- 25. Unfortunately difficult patients continueto exist. You can’t beat them or throw them out
- 26. The term “difficult”is subjective. Differences in expertise and experience account for differences in perception
- 29. Summary • Errors inhospitals would continue to happen • Sometimes, due to loopholes in processes • Face it; Don’t run away • Avoid being defensive or blaming people • Acknowledge patient’s emotion, empathize • Establish trust and diffuse situation • Learn from experiences by introspection
Editor's Notes
- #7 Why do patients become angry? What are the common “root” causes? 1. Pain. Medical illness is often accompanied by pain, so much so that pain is often considered the fifth vital sign. Assessment and treatment of pain is an important factor for all medically ill patients. Anger is a common emotion in patients with pain, especially chronic pain. It is thought that the presence of significant anger may in fact further aggravate the feeling of pain. Physicians must not only be able to assess pain, but also to weigh the benefits and the risks in prescribing analgesics. When any patient appears to be “angry,” the presence of pain, especially untreated/undertreated pain, must be considered and rectified as a matter of urgency. 2. Fear and worry. Being medically ill, especially if one is hospitalized, can be an intensely destabilizing experience for both the patient and his or her caregivers. In some cases, an unknown prognosis, the occurrence of complications or the impact of the illness on their independence, can make patients fearful about the future. This worry can manifest as anger, and since patients cannot direct their worry or anger toward their illness, this anger may be displaced onto people around them, including hospital workers. Attempting to recognize, and where possible alleviate, their worries is often very helpful. 3. Feeling unheard or uninvolved . Any patient who displays anger in a hospital setting is guaranteed to attract attention. For some patients the expression of anger may actually suggest that they feel “unheard” in the medical setting. They may feel that they do not have enough information about their condition or their concerns have not been addressed. The question then arises, how do we make them feel heard? Do they understand why they are in the hospital? Do they understand what their treatment options are? Do they feel they have been part of the decision-making process? Ensuring that patients feel they are involved in their care can reduce the anger that can arise out of being “unheard” in a hospital. 4. An unidentified medical condition or psychiatric disorder. Some individuals may become very angry or irritable in the context of a medical or psychiatric problem. Withdrawal from an addictive substance such as heroin or the presence of major depression or delirium can present with irritability or agitation. It is important to ensure that patients who present with anger are evaluated for the presence of an underlying psychiatric or medical condition.
- #9 Why do patients become angry? What are the common “root” causes? 1. Pain. Medical illness is often accompanied by pain, so much so that pain is often considered the fifth vital sign. Assessment and treatment of pain is an important factor for all medically ill patients. Anger is a common emotion in patients with pain, especially chronic pain. It is thought that the presence of significant anger may in fact further aggravate the feeling of pain. Physicians must not only be able to assess pain, but also to weigh the benefits and the risks in prescribing analgesics. When any patient appears to be “angry,” the presence of pain, especially untreated/undertreated pain, must be considered and rectified as a matter of urgency. 2. Fear and worry. Being medically ill, especially if one is hospitalized, can be an intensely destabilizing experience for both the patient and his or her caregivers. In some cases, an unknown prognosis, the occurrence of complications or the impact of the illness on their independence, can make patients fearful about the future. This worry can manifest as anger, and since patients cannot direct their worry or anger toward their illness, this anger may be displaced onto people around them, including hospital workers. Attempting to recognize, and where possible alleviate, their worries is often very helpful. 3. Feeling unheard or uninvolved . Any patient who displays anger in a hospital setting is guaranteed to attract attention. For some patients the expression of anger may actually suggest that they feel “unheard” in the medical setting. They may feel that they do not have enough information about their condition or their concerns have not been addressed. The question then arises, how do we make them feel heard? Do they understand why they are in the hospital? Do they understand what their treatment options are? Do they feel they have been part of the decision-making process? Ensuring that patients feel they are involved in their care can reduce the anger that can arise out of being “unheard” in a hospital. 4. An unidentified medical condition or psychiatric disorder. Some individuals may become very angry or irritable in the context of a medical or psychiatric problem. Withdrawal from an addictive substance such as heroin or the presence of major depression or delirium can present with irritability or agitation. It is important to ensure that patients who present with anger are evaluated for the presence of an underlying psychiatric or medical condition.
- #27 Interpersonal in nature Difficulty in dealing is a function of the relationship Based upon discomfort with What has happened What might happen
- #30 The #priority at this stage is to resolve the issues as early as possible. Accepting mistakes and working on solutions without delay Individuals should learn from these mistakes and take up finding a solution as a challenge. Preparations to avoid such mistakes in the future should be given priority and repetitive annoying problems should be avoided. This way the processes are updated and people have an added responsibility to acquire this as a part of their skill set. there should be prioritisation of activities there should also be a contingency plan ready, so that in case of emergencies backup plans can be executed to avoid further damage which is caused by the human errors. If such plans are followed, it minimised the risk and also gives stability to the process execution. However, giving this priority to solve the problem shouldn't lead to neglecting other parallel tasks and activities. The other independent processes should not be halted when individuals are finding solutions to the problems. Infact, the challenge lies in solving the issues without disrupting the functioning of other processes "A Good day means everything is fine.. sssss Bad day means you've gained some new experience and have to fight the challenge"