A patient is mad. They are raising their voice, demanding answers, complaining about the wait or saying no one is listening.
This is a difficult situation for health professionals. A typical reaction might be to tell the patient why he’s wrong, defend the organization or quickly correct the patient.
But sometimes those answers can make things worse.
The goal is not to win the argument when a patient is frustrated or upset. The goal is to de-escalate tension, understand what is going on, communicate clearly, and maintain a professional interaction. Effective communication is also linked to patient safety. The Agency for Healthcare Research and Quality says communication is a critical component of safe, patient-centered care and communication failures can provide opportunities for harm.
But what do healthcare professionals actually say when a patient gets difficult?
And how do they de-escalate the situation without getting defensive or losing control of the conversation?
Here are some practical ways to communicate effectively.
Know What’s Behind the Behavior
One of the first mistakes healthcare providers may make is to immediately label an angry patient as a difficult person.
The behavior can be harsh.
But maybe there's something in it.
The patient might be in pain. Perhaps they are afraid of the diagnosis. They might not know what is going on. They could have been waiting a long time. They may be concerned about a family member. Or maybe they just think no one is listening to them.
That doesn't mean everything goes. “Patients and health care professionals still have a responsibility to maintain a respectful and safe environment.
But knowing what might lie behind the frustration can inform how a healthcare professional responds.
How about these two answers:
- “Nothing I can do about the waiting.
Against:
- I know you have been waiting, and I can see why you are frustrated." Let me see where we are."
The second reply does not promise something that the health care provider cannot deliver.
It validates the patient's concern and pivots the discussion to a potential fix.
That distinction is important.
A patient who feels ignored can become more frustrated when the response is only about policies, procedures or what the healthcare professional can’t do. An answer that shows you understand the concern can open the door to learning what the patient really needs.
AHRQ patient-safety resources have highlighted effective communication between patients and health care professionals. In a patient safety conversation about patients who wanted to leave the hospital against medical advice, active listening, acknowledging frustration, and de-escalation were identified as communication approaches that might help address underlying concerns.
To know the behavior is not to condone the behavior.
It means to look beyond the feeling of the moment and discover what is really happening.
Don’t Mirror the Patient’s Emotions
It’s natural to become defensive when someone raises their voice.
You can speak faster.
Your voice may get louder.
You can start interrupting.
And now we have two people talking instead of one person listening.
That is why one of the most important communication skills in a difficult patient interaction is to control your own response.
- Take it easy.
- Use a calm voice.
- Listen, then respond.
- And don’t jump in to correct every statement the patient makes.
For example, let's say a patient says:
“Nobody here gives a damn about me.
A possible defensive answer could be:
"That's not true. We've been taking care of you all day,"
Even if the statement is factually unfair, arguing about it may not deal with the underlying concern of the patient.
Instead a health professional might say:
"It sounds like you feel like your concerns have not been heard."
It doesn't mean agreeing with everything the patient has said.
This means dealing with the concern before moving on to the actual issue.
Empathy is not consensus.”
This means showing that you have heard and understood the other person’s concern.
And this is even more important when emotions run high. A reply such as “I understand what you’re saying,” may allow for a more productive discussion than trying to immediately prove the patient wrong.
The issue of de-escalation is increasingly important in health care. The American Hospital Association’s current healthcare de-escalation resources focus on communication techniques and preparedness to respond to challenging interactions and decrease the risk of escalation. American Hospital Assn.
The patient’s behavior is not always controllable by the health care professional.
They can choose their reactions.
Ask Questions to Find the Real Problem
Wait until the discussion has died down, and then ask your questions.
Sometimes one complaint can sound like several different problems.
“A patient could say, "
“It’s been awful.”
Instead of rushing to the organization’s defense, consider:
“Tell me what has been most frustrating?”
That question can show the real issue.
The patient may not even understand the plan of treatment.
Perhaps they received different information.
Maybe they don't know when they are going back home.
Maybe they're afraid of medication.
Or maybe they just want somebody to tell them what happens next.
Good questions move a conversation from emotion to information.
You can also summarize what you heard:
“So, if I understand correctly, your biggest worry is that you’ve not heard anything since this morning. Am I correct?”
Now there is a chance for both sides to make sure they are talking about the same problem.
Such communication can be very valuable in healthcare, because misunderstandings are not just annoying. They can impact the patient's understanding of their care.
AHRQ has identified communication as a key patient safety component and notes that communication occurs at many points between patients, families and health care professionals. When those points of communication fail, they can open opportunities for harm. PSNet
Questions also help to prevent assumptions by a healthcare professional.
- Ask instead of assuming an angry patient is angry about the wait.
- “Make sure the patient understands the treatment plan rather than assume she does.”
- Find out what happened instead of deciding that the complaint is unreasonable.
Sometimes the best way to diffuse a situation is to find the real problem.
Use Structured Communication When It Is Useful
Not every difficult patient encounter can be resolved in one conversation.
Healthcare professionals also work as a team, and communication between team members can affect the experience of the patient.
There are structured communication approaches that can assist here.
TeamSTEPPS was developed by AHRQ and the Department of Defense to provide evidence-based tools to improve healthcare teamwork and communication. Its resources include structured communication methods such as check-backs, briefs, huddles, handoffs, and closed-loop communication. PSNet
For example, closed-loop communication can confirm that an important message has been received and understood.
The general principle is simple:
Just because you delivered information doesn't mean communication was successful.
Ensure that the other person understands what was communicated.
This is especially the case if the patient has queries about what will happen next.
A health professional might respond:
“Before we wrap up, can you tell me what you think the next step is?
This kind of “teach-back” method can help catch misunderstandings before they become bigger problems. AHRQ’s TeamSTEPPS resources include teach-back as one of the communication tools for confirming understanding. AHRQ
Structured communication can also help health care teams to be consistent in their communication when a situation becomes challenging.
Know What to Say–and What Not to Say
There are some phrases that can make you feel worse when you’re upset.
Avoid statements like:
- “Keep it light.
- “That is not my concern.
- “You’re being overdramatic.”
- "I can't do anything."
- “That’s our policy.
Even if a policy is truly relevant, repeating the policy will not necessarily address the patient’s real concern.
Don't dwell on what you can't do. Instead, focus on what you can do.
Try:
- "That's what I can do.
- “Let me see what’s happened.”
- “I want to be sure I understand your concern.
- "Now I'll tell you what happens next.
- I can call my supervisor if we need more help.
These responses keep the conversation on topic rather than on argument.
The difference may be slight but the message behind it is different.
The healthcare professional is saying “Let’s find out what can be done from here” rather than “This is your problem”.
Of course, health care providers can't always give patients the answer they want to hear.
It may not be possible to request.
There may be no way to avoid a wait.
“Not every treatment is appropriate.
There might be a policy to follow.
Professional communication doesn't mean promising to appease someone.
That is, explain the situation clearly and respectfully.
Watch Nonverbal Communication
It’s not just about the words.
The way a message is received can be affected by tone of voice, facial expression, posture, eye contact, gestures and physical distance.
A healthcare professional might offer pleasantries but convey frustration through their tone or body language.
For example, saying
“Got it.”
While looking away, sighing, or appearing impatient might send a very different message.
Healthcare providers should be aware of their nonverbal communication during difficult encounters.
Not that you should act out of a script or attempt to look unnaturally calm.
This means being aware that the patient is responding to the whole interaction, not just to the words that are spoken.
When the conversation is tough, a calm voice and respectful body language can confirm professionalism.
And then sometimes it may be better to let the patient talk uninterrupted for a moment rather than try to explain immediately.
Recognize When De-Escalation Is Not Enough
There’s a key limitation to communication skills.
Not every escalating situation should be expected to be resolved personally by a healthcare professional.
“If a patient becomes threatening, violent or an immediate safety concern, the answer is not to keep talking and hope for the best.
Health care workers should adhere to their organization’s policies and seek assistance as appropriate.
De-escalation is the lowering of tension where it can be lowered.
We’re not talking about putting health care workers at risk of their lives.
The American Hospital Association has highlighted de-escalation as one of the key components to dealing with incivility and violence in healthcare settings. The recent guidance addresses prevention, response, recovery, workforce training and the use of appropriate behavioral emergency resources.” American Hospital Assn.
Clear procedures should be in place for when healthcare organizations need to provide more support.
Depending on the setting, this could be:
- A supervisor
- Security
- Behavioral health professionals
- Another designated response team
The key difference is knowing the difference between a frustrated patient who needs better communication, and a situation that needs intervention.
Need good communication skills.
They do not replace workplace safety procedures.
Wrap Up Clearly
And when you walk away from the immediate issue, come back.
Explain to the patient what will happen next.
For example,
So this is what we’re going to do.
“Let me go and talk to the nurse. We’ll get back to you with an update.”
"Your move next is..."
"Any questions on the plan before I leave?
This final step can help avoid another round of confusion.
It also enables the patient to ask questions before the interaction is over.
Communicating clearly is more than simply dealing with conflict.
It’s about ensuring that the patient knows what to expect.
This can be especially important when there are multiple healthcare professionals involved in a patient’s care. AHRQ’s patient-safety resources include the importance of communication at every step of the patient’s journey through the healthcare system, from diagnosis to treatment to transitions in care. AHRQ
The patient should walk away from the conversation knowing, when possible:
- What was talked about
- What is coming next
- Who is responsible for next step
- When they should expect an update
- Who to contact if their issue is different
An uncertain interaction can be turned into a manageable one with clarity.
Difficult Patients’ Communication Challenges
It’s all too easy to brand someone a “difficult patient.”
But that’s not necessarily a problem that helps a health care professional solve the problem.
A more useful question is:
What’s standing in the way of this conversation and what can I do to make it happen?
Sometimes the answer is more information.
Sometimes, it’s just listening.
Sometimes it’s acknowledging the frustration.
Sometimes it is saying no.
And sometimes it is recognizing that the situation has gone beyond a communication problem and requires further support.
The point is not to make every patient happy.
Healthcare providers cannot control all outcomes, eliminate all waits or meet all demands.
The idea is to be able to speak in a professional and safe manner, even if the conversation becomes difficult.
When Healthcare Communication Training Comes in Handy
Communication skills are learned and developed by practice.
Healthcare professionals could benefit from training on:
- Communication with patients
- Active listening
- Empathy
- Difficult conversations
- Conflict management
- Teamwork
- De-escalation
Training might offer a more controlled environment to learn how to spot communication issues, role-play various responses, and learn how communication impacts patient experience and team effectiveness.
Training, however, can’t solve every difficult patient encounter.
Healthcare organizations also need:
- Adequate staffing
- Policies
- Escalation procedures
- Leadership support
- Workplace safety measures
The best approach is one that pairs individual communication skills with corporate systems that support health care workers when things get tough.
Practical Implications for Healthcare Providers
Principles to keep in mind when dealing with a frustrated or angry patient:
-
Listen before you react.
Don’t get defensive about yourself or the organization. -
Search for the real concern.
Frustration can stem from pain, fear, confusion, waiting, uncertainty and feeling ignored. -
Recognize, but not necessarily concur.
Empathy is recognizing you heard the concern. It doesn’t mean agreeing with every statement. -
Ask questions.
Discover what is really bothering you. -
Keep control of your response.
Do not match the patient’s volume or agitation. -
What can you do?
Stop telling me what can't be done. Tell me what the next practical step is. -
Communicate clearly.
Make sure the patient understands what will happen next. -
Know where to draw the line.
Healthcare workers should never have to accept threats or violence as part of their ability to communicate. -
Ask others to help when you need it.
If a safety concern arises, follow the procedures of the organization.
Continue Developing Your Healthcare Communication Skills
Working in health care, difficult patient interactions are a reality.
But an angry or frustrated patient doesn’t mean the conversation has to turn into an argument.
- Listen before you react.
- I understand your concern.
- pose questions.
- Keep your cool.
- Tell me what you can do?
- And when the time comes to get in some extra support.
Good patient communication isn’t about having the perfect answer for every situation.
It's about setting up a professional conversation where the patient feels heard, the health professional is in control and the next step is clear.
Healthcare professionals interested in further developing these skills can find healthcare communication courses, professional development opportunities, and other healthcare training to continue building their communication competencies.
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