What do you do when faced with challenging patients? A patient who barges into the consultation room without invitation and demanded unhesitatingly to talk to you, failing which he will call the minister of health or even the prime minister if he has to?
So… fellow medical students, house officers, medical officers and my fellow respectable colleagues who are working with me as clinical specialists and specialists for such skills may not be learned from the text, but through experience and of foremost importance, humility. Nothing is impossible, and there is always a way out.
- INTRODUCTIONS: Slowly stand up, put on a smile on your face, extend your hand and introduce yourself while offering him a seat. Ask for his name and offer what you can do for him while wait for him to vent. If you have a coffee club, you may even allow yourself that small bit of a knack by alluding to some beverages nearby for him.
- LISTEN: After listening to him venting his frustration (at this juncture, words not described in the Oxford dictionary may find its way into the discussion and that should not in anyway appall you for I find the best way to endeavor such situation is by putting on a neutral facial expression) explain to him that you can see that there has been some form of misunderstanding and that you can clearly see that he is not happy about it.
- BACK TO BASICS: Reinstate the fact that you need some time to go through the notes that he has passed on to you so that you can refresh your memory as to what has happened. By doing so you are then able to reconstruct from basics as to what went wrong. Ask him whether does he mind if you take a few minutes of his time (not your time) to go through the papers.
- MANAGE HIS EGO: But right before that try to make a scene by calling in your nurse and telling her that the outpatients would need to wait for a moment as you are dealing with a major problem here. This reinforces the fact that you are making this angry man feel important. Somehow, you know that he adores the attention (who doesn’t?) and by doing so, you may certainly or at least partially defuse his anger a few notches down. Deal with this carefully. Done right, you exude a form of charisma that would paint you as a caring doctor that you prioritize your patients’ significance first by letting them know why they have to wait.
- BE THOROUGH: Go through the notes thoroughly and identify any problems, mistakes or oversights. Example; in this case a junior doctor may have made a mistake.
- NO EXCUSES: Know that these excuses mean nothing to the angry man. Thus, avert from offering them unless he presses for further information. Do not put the blame on your junior doctor as this reflects poorly on your sense of supervisory skills and shifting blame is just another skill imparted on the lack of professionalism, which is not what we encourage here. Having gone through it all, put the paper down and look up at the man.
- ADMIT: Tell him that you have gone through it and agree with him that something has indeed gone very wrong and admit the fact that this is a serious matter. For had it been trivial would he come in the first place? I’ve seen fellow colleagues where at this juncture on top of shifting the blame to another doctor they would rub salt into a gaping wound by informing the man that this is actually a small matter and can be rectified immediately. That would have been one heck of a precipitant to throw the man from boiling hot to lava hot.
- Even if you feel that this matter might have been trivial, it is not to the patient. Apologize profusely and show him that your primary concern is the patient. Showmanship goes a long way as they say during examination, but clearly, this serious business is neither for pleasure nor for showmanship. A mistake has been committed and a very serious one, thus patient safety takes precedence before anything else. Side effects are imminent and that should be your priority.
- BE OPEN: Following which, one should direct the consultation towards an open approach. Let the man ventilate his frustration. He may be very frank as experience has educated me well on this and he may even suggest methods to rectify such a problem from happening in the future. He may lavish you with gifts that come in a form of threatening to lodge a formal complain or go to the press, but whatever it is, your objective should not be one to aggravate and frustrate further. One should try to minimize the impact and prevent further collateral damage. Make it a point to apologize every now and then and make it an effort to listen to him and not silence him when one can clearly see that he is in fact opinionated and has a lot to dwell on. Interrupting a train of thought is one of the most antsy thing to do to a person and I’m sure that each one of us has experience of these every once in a while and know how disruptive it can get.
- NO GUNG-HO: I have seen gung-ho colleagues, stymied by the fact as to what to do next; encouraging patients to carry on with their official complain without first redressing the situation themselves and that can be very wrong, as it is a form of aggravation and passing on the red tape. Make it a point to address the situation yourself first and tell him that following this complain you will lodge an internal investigation together with your immediate specialist in charge to find out what actually happened and get back to him as soon as possible. Ask him how he feels about it.
- BARGAIN: At this point, the man can have two options. Regardless of which, it is his right and having bargained with the aforementioned offer, you can either try to persuade him again should he remains adamant of his standing to lodge an official complain to the hospital director. Such bargaining skills come with experience and you can offer him a preliminary investigation towards the incident and should he remains unsettled with the result, he can then opt to complain to the higher authorities. Fortunately, there are many who are happy enough to let you carry out the investigation and get back to them when the whole deal is completed. Such virtue reflects the responsibility and many people adore this characteristic in a doctor.
- ENSURE TRANSPARENCY: Before calling the matter close, one needs to remember the hidden agenda that may or may not be present. This takes tactful hints to bring it up so as to assure the man that you are doing everything possible within your capacity to ensure transparency and that nothing will be swept under the carpet. Hidden agendas can be varied and identifying them reveals your other virtue – caring and concern. For after all, isn’t that one of the cornerstone of healthcare? There may have been a recent equal incident that they may have suffered from and was not subjected to a formal hearing of their complains, not unlike now that they have met you.
- CLOSING: Some methods that I’ve picked up along the way while preparing for my exam for communication skills in picking up hidden agenda would be clipped words and phrases that go along the line of ‘is there any other concerns, pressing issues or worries that you would like to confide in me so that I could address them and aid you in as much as possible?’ OR ‘before we close this consultation, is there anything else that you would like to share with me?’ If there’s none, end the discussion, promise that you will get right to it and get back to him as soon as possible. Congratulate him on bringing up this matter as it will help you and your team members improve in your working ethics and be extremely cautious in the near future. Admit again that this problem is inexcusable and thank him for coming and pointing it out. Reinforce the fact that patient feedback is of the utmost significance in helping to improve for the betterment of patient care (sales representatives use this as their motto and so as that of major corporation – but whether they carry out the after-sales services true to their word is another matter altogether).
Such subtleties or nuances in phrasing your words go a long way. Try it the next time you have a chance and see how patients or family members react to them. I’m sure it would have been a positive remark. Many other situations do exist in terms of dealing with challenging patients but the famous parlance that refers to the phrase ‘the players may have changed but the game stays the same’ applies here nonetheless. My method may not be the surefire way of calming down patients, which goes to show that communication is a two-way agenda. Be flexible, respond properly, act professionally, be empathic and apologize if you are in the wrong. More importantly, shoulder the responsibility that is expected of you and play not the blame game for that is one that is often frowned upon. Failure to defuse the angry patient is not a failure that one should harbor resentment upon themselves. Rope in your senior colleagues if you do fail and offer the complainant another option to vent their anger should you fail to calm them. Experience tells me that they return after seeing my consultant and give me a pat on my back for a job well done.
Good luck!
[This article belongs to The Malaysian Medical Gazette. Any republication (online or offline) without written permission from The Malaysian Medical Gazette is prohibited.]