Angry patients are difficult to encounter mostly because of the reaction that they may elicit in others who are trying to care for them. Our natural tendency is to respond to anger with more anger, which always makes everything worse. The relationship is definitely strained after that if not irreparably destroyed. This is obviously not good for either side, and both people come out of this situation miserable, stressed and generally unhappy.
The first thing to do if an angry individual confronts you is NOT get angry. Restrain your emotions. Be concerned about the fact that the patient is obviously upset. Try to take on a helpful attitude. Let them know that whatever is their concern will become your biggest concern. NEVER return anger with anger.
Allow the angry person to ventilate. Sometimes it’s a good idea to just listen to the complaints for a while. This is therapeutic in and of itself, particularly if the individual is just trying to release some pent up frustration. Just try to be as supportive and helpful as possible. You don’t have to agree with what the person is saying but you can always say something like, “I’m sorry you feel that way”.
Try to figure out why the person is upset if it is not immediately apparent. Perhaps, the problem could be something that is easily fixable, after which the anger could be quickly resolved. Try to accommodate reasonable requests as much as possible. Be flexible.
Remember that anger may be a manifestation of some other emotion or fear, and anger is how this particular person is expressing his/her inner discomfort. Fear, anxiety, stress, depression, paranoia and other psychological issues may be expressed as anger. The person may actually be angry about an entirely different problem in his/her life, but when the poor phlebotomist comes in to draw blood early in the morning, s/he gets the brunt of that welled-up stress. Unfortunately, then the patient gets branded with terms like nasty, noncompliant, uncooperative, etc.
The anger may be an attempt, consciously or unconsciously, to manipulate people or to be in control of a situation in which control is perceived to have been lost. If you allow the person to have a little control over what is happening to him as long as it’s safe to do so, this may help considerably. If the person is intentionally manipulative, this will require some firmness in your approach, but again, never anger, and always with the overall goal of providing the best care for the patient.
If the person is upset about something external to yourself, it may be easier for you to comfort the patient and try to help rectify the situation. If the anger is directed toward you, the situation will probably be more difficult, but usually still very manageable. Again, try to understand what it is that made the person angry. If it was your fault, own up to it, apologize for any stress that the problem may have caused and try to fix it if possible. If you have a good reason for why you did or didn’t do something that the person is angry about, try to calmly explain your point of view without being overly defensive.
There are some authorities in risk management who would like for us never to apologize for anything, but I don’t agree with that. I think most reasonable people, and especially ones with whom you have built a good relationship with in the past, would accept an apology for an indiscretion and that may diffuse their anger. Of course, it depends on the situation. Also, remember that there are ways to express sympathy for a particular situation without having to take personal responsibility that could be construed later as an admission of wrongdoing. For example, one could say, “I’m really sorry this had to happen”, rather than “I’m sorry I let this happen”.
All of the above assumes that you are dealing with a reasonable and rational individual. If not, you do have to be very careful what you say so that it cannot be used against you later; but at the same time, try to be as understanding and concerned for the person’s well being as much as possible.
If the anger is directed against you and if it is indiffuseable, it’s best to step back from the situation and perhaps ask the patient if s/he would like to change doctors (or nurses). If so, then gracefully agree and allow that process to happen. Place a call to a colleague then to explain the situation in nonjudgmental and professional terms and ask him/her to assume care if they will. This call should come from you, not from the nurse or care partner or family member.
If you are on the receiving end of a call from a patient in the hospital who wants you to assume their care, you are not obligated to do so; but if you agree, you should ask the patient to talk to his/her doctor about it and if it is decided that this is in the best interest of the patient, then the patient should request that his/her doctor call you for a smooth transition. You should never just show up and take over without the proper communication.
If the person is angry over a relatively minor issue, there is probably some other reason for the anger than the incident in question. For example, depressed patients become very irritable over minor problems. There may be a metabolic or physical illness that is contributing to the patient’s behavior. If the person seems irrational and unduly agitated, try to think diagnostically about what is causing that behavior – like drug effect, thyroid abnormality, brain dysfunction, drug or alcohol withdrawal, or “sundowning” in a patient with early dementia. Enlist the help of the family if necessary to come and sit with the patient, while you try to figure out what the pathology is that explains the behavior.
Most of the time, the issues that create anger in patients or families are resolvable and, indeed they should be resolved as quickly as possible. You should never let this linger or ‘fester” any longer than absolutely necessary. The anger will only get worse if you don’t address it quickly. Angry patients usually become noncompliant and distrustful eventually. The doctor-patient relationship can become irreparably destroyed and, in that case, either the patient will need to make a change or you will with regard to transferring to another health care professional. Don’t try to persist with a relationship that doesn’t exist.
This page was last updated on Feb. 15, 2009.
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Moses Leaveth Pharaoh in Anger