The Upset Patient Protocol

We’re not trained in conflict resolution, but angry patients are a reality in any practice. Listening and empathy can go a long way in this situation. Dike Drummond, a.k.a. The Happy MD, give a step by step strategy for engaging with upset patients.

Link to detailed explanation and video description of the Universal Upset Patient Protocol

Link to Primary Care RAP

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Pearls

• There are 6 steps to the conversation with a patient who is upset.  

  • “You look really upset.”

  • “Tell me about it.”

  • “I’m so sorry this is happening to you.”

  • “What would you like me to do to help you?”

  • “Here’s what I’d like us to do next.”

  • “Thank you for sharing your feelings with me.”

• An encounter with an angry patient is stressful to the overwhelming majority of providers.  It can ruin your day (or days) and that of everyone else in the office.  Medical training does not prepare students to handle these situations.

• The upset patient protocol is a way of structuring a conversation with an upset patient.  It is a doctor-patient communication tool which encourages the patient to share and vent his/her feelings.  After listening to the disgruntled patient, the protocol helps the physician wrap it up so that he/she can proceed with the clinical part of the office visit.  This protocol works about 85% of the time with angry patients, regardless of the source of the upset.  The remaining 15% will stay upset despite your best efforts to placate them.

• Step 1:  Notice the patient is upset.  

  • Take a deep breath, get present, and make sure that you are centered when you walk in the room.  If you do not notice that a patient is upset, he/she will get even more angry, assuming that you don’t care or that you’re clueless.

  • Sit down.

  • Show that you recognize the patient is upset by saying, “You seem upset.”

• Step 2:  Invite the patient to talk about it.

  • Give the patient permission to tell you about their frustration by saying, “Tell me about it.  Tell me what happened.”

  • Let the patient speak or vent frustration without interruption.  Refrain from being defensive.

  • Breathe and remember Theodore Roosevelt’s phrase:  “They don’t care how much you know until they know how much you care.”   

• Step 3:  Show empathy for the patient’s situation and apologize.

  • You can be sorry for the way the patient feels or for his/her experience without apologizing for anything that you have done.

  • Say something like,  “Wow.  I’m so sorry that you’re feeling this way.  That sounds so frustrating.  I’m so sorry this is happening to you.”

• Step 4:  Find out what’s their agenda.  

  • Ask the patient, “What would you like me to do to help you?”  

  • Sometimes the patient will say, “I just need you to listen.  I needed to tell somebody.”  Other times the patient will ask for something specific, which may or may not be reasonable.  If unreasonable, the provider needs to set boundaries around the relationship and decide what he/she is willing to do.

• Step 5:  Determine what you’re willing to do to address the patient’s concerns.

  • “Here’s what I’d like us to do next.”

  • If the patient requests something ridiculous (such as “Give me $10,000”), it is important to not laugh, get upset, or roll your eyes.  Respond with, “I can understand how you feel.  I’m not willing to do that.  You know that, right?  Here’s what I am willing to do.”  And then you tell them what you’re willing to do.

  • Emphasize what you’re going to do, and not what you’re not willing to do.  The negotiation should be very quick and, typically, you’re right back on track with their frustration diffused.

  • Usually, if you’ve listened to the patient and shown them how much you care, they’ll make a very reasonable request and something that is potentially within your power.

  • Once physicians inform patients about what they’re willing to do within the boundaries of good medicine, patients can then decide whether they want you to continue to be their doctor.  Never put yourself in a position with an upset patient where you feel you’re in danger.  For instance, never prescribe narcotics that you think are inappropriate.  Let the patient know that they’re perfectly capable of seeking a separate medical opinion from another doctor.

• Step 6:  Thank the patient for sharing his/her feelings and trusting your relationship.

  • “Thank you so much for sharing your feelings with me.  It’s really important that we understand each other completely.”

• The Universal Upset Patient Protocol does not work on 15% of patients.  Nothing works universally, and some patients will remain angry no matter what you say.

• Everyone in the clinic or office should be trained in the Universal Upset Patient Protocol.  Oftentimes, a receptionist or nurse can placate the patient so that the physician can focus on the medical issues that brought the patient to the office in the first place.  Ideally, physicians and other staff members should rehearse and practice these conversations, so that they are comfortable using these tools when an upset patient walks in the door.