Key Takeaways:

• Patients can bring difficult feelings into the clinic, sometimes because of diagnoses, or communication problems, or even issues at home.
• We can’t control how our patients behave, but we can control how we react.
• Set the tone yourself with calm, respectful language. Utilize active listening to show you are invested in the patient – ask open-ended questions, validate their feelings, and make eye contact.
  Recognize their feelings and times you have felt the same way and empathize.
• Debrief with yourself or a trusted colleague after a challenging interaction.

Mr. Doe is not feeling well, and has been waiting for his appointment for 20 minutes. It’s a wildly busy day at the clinic, and so his wait continues to drag on. Mr. Doe has had a challenging day at work, as well as difficulty getting to the clinic. Eventually, he is called in.

The clinic’s jam-packed schedule and staffing difficulties means Mr. Doe waits again in his room before seeing a nurse or doctor. Eventually he is seen, and told he requires a blood lab, where once more, he finds himself waiting. When the phlebotomist calls him up, he lashes out. “Finally! You people are so slow! What’s wrong with you?”

Meanwhile, the phlebotomist is having challenges of her own today, and the last thing she wants to see is Mr. Doe angry and yelling at her. These challenging interactions have negative impacts on everyone involved – healthcare workers may experience increased rates of burnout or stress, and patients may feel an erosion of trust. And unfortunately, difficult interactions like these happen all the time, for many reasons. What’s important in the moment is handling the situation with grace.

What Causes Challenging Interactions?

Challenging patient interactions can come from any number of factors. Miscommunication is a common root cause, whether that’s language and literacy proficiencies, misunderstanding medical information, or feelings of a power imbalance between healthcare provider and patient.

Perhaps a patient is expecting or has recently received bad news or a challenging diagnosis. Maybe they are grappling with feelings of anxiety, fear, grief, defensiveness, or anger. It could be that they’re dealing with insurance difficulties, or perhaps they brought some difficult feelings from work or home into the clinic.

Think about your own life, and the times that outside factors have influenced your interactions with others. We all have moments when we let the stress of one part of our life leak into other parts, or when big emotions take the wheel, even when we don’t want them to.

It’s important to remember that regardless of the cause of the behavior, your patients’ attitudes are often out of your control. But what you can control is your reaction to a difficult situation – and in so doing, you may even be able to reverse it.

Ways to Handle Difficult Patient Interactions

Imagine you’re sitting down with someone like Mr. Doe after a recent eruption, and he’s still visibly agitated. You suspect that unless his mood and his feelings are addressed, this is going to be a difficult appointment. Thankfully, there are a few different methods you can use to change the tone of your meeting.

Set the Tone Yourself

It’s worth remembering that we shouldn’t judge ourselves for our first emotional response to a situation – rather, we should judge ourselves by the actions we take afterwards. It’s not unfair to feel a moment of frustration, irritation, or anger in response to a challenging patient interaction. But you can’t act on that feeling. Allow it to pass and then compose yourself before modeling the behavior you’d hope to see from Mr. Doe.

This might look like sitting still, and speaking in a low, calm voice. Try to utilize collaborative language, using worse like “we” and “us” when referring to the patient and their situation. Set your boundaries while maintaining a soothing tenor, especially if the patient is expressing volatility or high levels of anger.

Setting boundaries with collaborative language may look like telling a patient, “It’s important to me that we find a plan that we both feel will work for you. To accomplish our goal, we must be respectful of one another. If we can’t maintain that respect, we may need to stop and pick up again at our next visit.”

Active Listening

One of the best ways to show respect and investment in another person’s feelings is active listening. Active listeners are focusing on the words they’re hearing, rather than planning a reply while listening. Not only does it ensure you hear everything the patient is telling you, it also helps the patient to feel respected and valued.

Hallmarks of active listening include:

• Validation: Validating the patient’s feelings helps them feel understood and shows that you’re paying attention. Many times, it feels good simply to be told, “I hear you and see how that could be difficult.” Sometimes, that’s enough to help someone further open up, and keep the dialogue moving.
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• Open-ended questions: Active listening will help you to hear everything your patient is saying and allow you to ask valuable open-ended questions as a result. Use open-ended questions to encourage your patient to share their feelings in greater detail, and to learn more about what they’re experiencing. These follow-up questions aren’t just valuable because they offer you new information, but also because it tells the patient you’re truly paying attention, and care about what they’re saying.
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• Paraphrase: Take what your patient has told you, and reiterate it back to them, asking them if you’re understanding correctly. This will help you to clarify anything you may have misunderstood and also reinforce the fact that you have been paying attention.
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• Eye contact: Making eye contact with the patient is very important. It shows the patient that you are present and attentive and helps to convey empathy while reassuring the patient that you take their concerns seriously.

Recognize and Empathize

Recognizing your own experiences in your patient, and then empathizing with them, is a powerful tool. Take a beat to acknowledge the feelings a patient like Mr. Doe may be having and try to remember times when you yourself have been in a similar situation.

Consider that Mr. Doe’s anger could be the result of difficulties coping – perhaps a new diagnosis has him feeling concerned about the future of his well-being, or as if his body has betrayed him. Remind yourself that your patient may be feeling scared, helpless, or stressed about their medical situation. And if that patient doesn’t feel as if you’re empathizing with their difficult experience, they may feel they are not being taken seriously.

Acknowledging your patient’s challenges and considering how you would feel in their shoes can go a long way to helping you change the tone and pace of your interaction.

Debrief

After a difficult patient interaction, it’s worth taking some time to debrief with yourself or with a trusted colleague. Debriefing helps us process recent experiences, especially ones that cause stress or take an emotional toll, and is part of moving on from those experiences, as well as improving our reactions to them.

Consider what worked for you during your interaction with Mr. Doe, and what didn’t. This will help you to build a strategy for similar situations moving forward, showing you what to embrace and what to cast aside.

Similarly, take a moment to reflect on yourself and your feelings during that interaction. How did their words and emotional state make you feel? What reactions could you feel bubbling to the surface that you either embraced or pushed aside? How did the patient react to you during the encounter? All of this is valuable information that will impact your future interactions.

Sometimes challenging patient interactions are unavoidable, and they can be a serious sour note during the day. But by using some of the techniques listed above, you can mitigate those challenging moments during your day, and possibly even reverse someone’s mood altogether. Next time Mr. Doe lashes out, you’ll be prepared to answer his challenging feelings with grace.