This article was reviewed on 11.1.18 by Dr Ravi Ramanathan.
Dealing with angry or anxious patients can be emotional, especially if the anger is directed towards you or a colleague.
Being ill makes people anxious, which sometimes spills over into anger. Delayed appointments are a common reason for anger, but the visceral anger often precipitated by anxiety for a loved one's well-being is commonly seen by doctors.
Third-party fury can be more intense than the anger of an individual and can become overheated if egged on by colluding friends and relations.
The triggers include patient concerns that they are not being taken seriously, disappointment at the lack of therapeutic success, and misunderstandings, such as when the patient expects one treatment but gets another and the doctor fails to explain the rationale.
Patients or relatives feeling frustrated or guilty that they should have come to the surgery sooner or cared better is another common reason for anger.
Anger is natural in grief or when adjusting to a serious diagnosis. For most angry patients and relatives anxiety is often the trigger.
Reflection and legitimisation
Two of the best strategies to shorten the period of anger are reflection and legitimisation. An example of a reflection statement is: 'You are upset because you think I do not really believe you are suffering.'
These statements are often more effective than direct questions, which can be seen as intrusive or confrontational.
After several simple reflective comments, legitimise the patient's anger. For example, you can say: 'I can understand why you are upset. You came to me to find some physical cause for your pain. I cannot find any problem and now I am sending you to a psychiatrist. I might be upset also, if I were in your position.'
This expression of understanding and legitimising your patient's emotion is reassuring to them. It usually prevents any further problems and is a powerful method for establishing trust and rapport between the doctor and the patient.
When we make a genuine attempt to understand a patient's emotion, it is almost always possible to make an honest legitimising comment.
- Remember it is the patient who is angry, not you. This may be difficult depending on your temperament. It is all too common for a simple misunderstanding to develop into an argument.
- Do not leave the anger unexplored. Glowering at each other through the consultation is not effective.
- Empathise with the patient. If you are feeling angry, it is very likely that the patient is too. Doctors feel anger if their competence is questioned or their integrity challenged. A lack of gratitude from seemingly ungrateful patients can make GPs cross, especially if they feel they have made a special effort.
- Be patient; anger usually does not last long.
- Always support other members of staff in the face of aggression.
- Sometimes gentle confrontation may help get to the bottom of the issue. Statements such as: 'You seem to be cross about something' or 'You were very angry with the receptionist, why was that?' may help the patient communicate why they are angry.
- In communication terms anger has a purpose - to gain the listener's attention. In this case, it is wise for the doctor to give the patient their full attention.
- Be aware of your body language when listening to the patient. Maintain non-threatening eye contact and try not to raise your eyebrows, purse your lips or adopt an aggressive stance. When you speak, break eye contact from time to time to demonstrate your wish to be conciliatory.
- When discussing the issues, deal with the main problem first, summarise each point and check your understanding with the patient.
- Acknowledge the frailties and imperfections of medical diagnosis and treatment. And be honest. Frankness about the nature of any delays will often defuse the anger.
- Acknowledge your own lack of omnipotence, and try not to feel guilt. If you do not bring some of these feelings into the open, your relationship with the patient may be irrevocably harmed.
- When there seems to be a real threat of physical violence, make every effort to defuse the situation and avoid physical confrontation. If possible, move away and get help. You may want to press the panic button, if you have one.
Dr Tate is a retired GP in Corfe Castle, Dorset, and the author of The Doctor's Communication Handbook