Blog | Monday, October 9, 2017

'Doctor, that patient and family are very upset'

It's a scenario that every doctor is familiar with. You are having a busy day and working full steam to get everyone better. You suddenly receive that unexpected message: “Mr. Johnson and his family are very upset and would like to speak with you now”.

Most of the time, any physician's initial reaction will be one of irritation, disappointment or frustration: “My goodness, I'm working so hard here and we have done so much for Mr. Johnson. What on earth could they be upset about?!” “They are so ungrateful!” “Such difficult people!”

This is such an important moment, because when anyone (not just a physician) perceives that someone else may be attacking them or their work, the natural default human reaction is to become defensive, angry, or worse still—attack back. It's a moment in many a physician's day which they don't handle as well as they could. This is for a number of reasons, including sadly a lack of communication skills training for medical students and physicians.

Here are the golden rules for when any doctor gets that inevitable call about the angry or upset patient or family member:
1. Take a deep breath
Dealing with this is part of a physician's job description. You are working in an emotionally charged field and meeting people at very low points in their lives. We must cut them, and their families, some slack in the emotions department. Being ill is a traumatic event, their whole life has been turned upside down, and they are frequently not themselves.

2. Do your homework before meeting
Try to get a handle (usually from the nurse) about what the problem is. Then familiarize yourself with all details of the illness and treatment strategy before walking into the room.

3. Listen
When you enter the room, walk in calmly and confidently. If you know what the problem is and it's appropriate, apologize for what has happened immediately. Or you can say something like, “Sorry for the misunderstanding” or “Sorry that this has happened”. Then comes a “Tell me what happened” statement. Ask them to explain what transpired and how they feel. Just listen, listen, listen. Absorb everything. Don't speak.

4. Go over things again
After they have had a chance to speak, it's your turn. Summarize succinctly what happened again, apologize for any mishaps, and then tell them how the situation will be corrected. Formulate a clear strategy and emphasize that you are now looking ahead to the future. Ask them what else they think you can specifically do to help.

5. Close the loop

Don't just disappear afterwards! Check in with them again either later the same day (ideally), or the day after, to make sure everything has been addressed and to show that you care.

Three things you should never do include: acting defensively, dismissing a concern, or escalating the situation by aggressively defending the situation—no matter how you feel.

It's my observation after years of practice that only a handful of people out there are really unreasonable. Well over 90 percent of the time, patient and family concerns and complaints have a solid basis.

By utilizing the right communication techniques, almost any angry or tense situation can be quickly calmed down. Get it wrong however, and things can spiral out of control very quickly. Ultimately, these suggestions would work in any customer service situation when you need to diffuse a situation, whether you are a doctor, a restaurateur, or a hotel manager (and even in your personal life too). People are people, and the same emotions always apply, as do the skills for dealing with them. Never under any circumstances respond to anger with anger, which only serves to pour fuel on the fire. Don't just react, but choose how you respond. Or as the famous neurologist and psychiatrist (and Holocaust survivor) Dr. Viktor Frankl said: “Between stimulus and response there is a space. In that space is our power to choose our response”. Deliberately go into the “zone” of being the active listener and problem solver, always showing the empathy and compassion of the good doctor.

Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care. This post originally appeared at his blog.