TMLT continues to receive urgent requests from physicians looking for ways to de-escalate angry patients or diffuse tense situations in the office.
To better help physicians, we spoke with two experts — Austin physician Dr. Bryan Sayers and defense attorney Stacy Simmons — in a recent episode of our podcast, TrendsMD. They offered several useful and practical strategies to help physicians manage difficult patient interactions. (Listen to the full conversation here).
When speaking with angry or disruptive patients, it’s important for physicians to realize that this is not the time argue or “be right.” It’s time to listen and acknowledge what the person is telling you.
“You have got to take a deep breath as you enter that room and go in with the idea, ‘I'm just going to try to get through this and let them say what they need to say. I'm not going to argue with them,’” says Dr. Sayers.
“And then you need to — other than just acknowledging that you're listening — keep quiet. Let them talk themselves out. They want to be heard. And they want to be acknowledged that they've been heard,” he says.
If you think you may need help with this kind of interaction, here are some phrases to facilitate the conversation.
(Please note that these phrases will not apply in every context. When responding to escalating behavior, consider the individual patient, the circumstances, and the overall situation. If at any time the patient threatens harm or you feel unsafe, contact the police or call 911 immediately.)
Let the patient know that you are focused on what they have to tell you.
- Tell me more.
- I understand.
- Please continue.
- I’m here to listen.
- Would you say more about that?
- I would like to understand more about what’s happened.
- I would really like to hear your thoughts.
- Tell me why this is important to you.
- Is there anything else you would like me to know?
Let the patient know that you heard and clearly understand their concerns.
- This is what I’ve heard you say so far.
- What I’m hearing is . . .
- I appreciate you sharing this with me.
- I can see how much this has upset you.
- I can’t ever know exactly what that was like, but I can see how much it has affected you.
- That’s a difficult situation to be in.
- That’s upsetting to hear.
- I’m very sorry you’re upset by what’s happened.
- I’m very sorry that this has been your experience.
- I’m sorry you’re going through this.
Help move the conversation to a conclusion.
- I’m very sorry to interrupt, but I want to make sure I understand everything before it’s time to go.
- I feel like we’ve talked this out as much as it is productive to do so. So let’s wrap up.
- I don’t think we are going resolve this today. Let me think about what you’ve said, and I’ll get back in touch with you.
- You’ve given me a lot to think about. I would like to take some time to really think about it and digest what you’ve said.
- I’m grateful for your feedback. But it may take some time to resolve your situation. Can I get back to you?
- I’ve never thought about it that way. Let me talk to my [colleagues/my office manager/the medical director] and see what [he/she/they] thinks.
- I may not be the best person to address your concerns. But I can find out who is.
For more on de-escalation in the medical practice, please see the following resources.
- CME course: De-escalation of angry or disruptive patients
- TrendsMD Podcast: How to de-escalate disruptive patients safely and effectively
- Tips for de-escalating angry patients
- Managing difficult patients