THCB

The Angry Patient: A Primer For Physicians.

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Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.

The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several different categories. By understanding and thinking about these categories, physicians can begin to identify the root of the anger and take measures to address it. This exercise might seem simplistic at first. However, you’ll be amazed by how powerful the results can be.

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.

Collateral and risk

Obtaining collateral information from their family members, caregivers or other health care professionals is also often illuminating. Ensuring that the medical team is delivering a consistent message to patients regarding their treatment is also useful, as conflicting messages may undermine the patient’s confidence in the medical team.

Anger may suggest that there is a risk of violence. It is therefore important to ensure that an assessment is undertaken to reduce the risk to the patient and people around him.

Summary

In summary, there are many situations where physicians may have to deal with patients who are angry. In most cases the most helpful intervention is to look past the anger and attempt to identify, and alleviate, the underlying reason for the anger. Attempting to do this in a busy clinic or hospital setting can be quite difficult and requires both perseverance and practice.

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14 replies »

  1. I can completely see number 3 as being a leading cause for anger and/or high emotions considering how many patients are affected by this year after year. I want to shine a light on a movement that has started and many think will benefit the delivery of healthcare. The movement of patient-centered care has actually been proven to improve the doctor-patient relationship over a long period of time. This has also proven to result in fewer medical malpractice due to negligence incidents and deaths.

  2. Maybe I was too harsh…

    But the specific instances I’ve seen of truly gross disrespect did not come from medical personnel, but scheduling & billing and so on. So I was not referring to nurses nor aides. I’ve seen those people be harried & brusque, but never outrageous misbehavior.

    (OK, you want an example: someone who would schedule a pt for a clinic visit on a day which you’re not scheduled to be there, then when the pt shows up blame her, reschedule her for another clinic and hand her an apt card, but once again have scheduled her for a day when you will not be holding clinic, then when the pt shows up WITH THE APT CARD WHICH STAFF FILLED IN, deny it, get really nasty, accuse the pt of stealing apt cards and filling them in herself, and accuse the pt of drug-seeking behavior. And that’s just one example…)

  3. Sribe, I completely agree … was just looking for you to elaborate on whom your support staff was. Whether it be RN’s, Nurses Aides? I think everyone on an interdisciplinary healthcare team should have better communication. I feel that we’re all stretched so thin that being over-tired and over-worked manifests itself as disrespect toward patients sometimes.

  4. WHY??? I certainly could be more specific about the particular instances I have experienced, but NONE of your support staff should be grossly disrespectful toward patients, and NONE of them should be incompetent.

  5. To deal with a patient having anger issues can be tough but we must look beyond his anger and understand the real reason behind his anger issues.

  6. I am working as an independent health care consultant and i think most of the situation which mention in this article can be avoid by using EHR properly.

  7. “3. Feeling unheard or uninvolved”

    My first feeling of anger. Patients need to be aggressive in making sure they are not considered just another input of production.

  8. Given the state of user interfaces of EHRs, don’t you think this is more likely to escalate the patient into a full-on homicidal rage?

  9. Give them all portals to their EHR to keep them occupied. That will assuage all anger,

  10. You left out bald incompetence on the part of support staff, and grossly disrespectful behavior toward patients–both things which I have witnessed on occasion.

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