Managing Expectations Helps Physicians Avoid Angry Patients

August 9, 2010
Ed Rabinowitz

There are many reasons why, on any given day, one or more of your patients might have a short fuse. There are also four essential steps doctors need to take to handle angry patients: Anticipate, Acknowledge, Apologize, and Make Amends.

There are many reasons why, on any given day, one or more of your patients might have a short fuse. A recent job lay-off. Troubling relationships at home. Flare up of a chronic medical condition. Delayed lab test results. Or, simply getting up on the wrong side of the bed. According to Kristin Baird, RN, president of The Baird Group, there are also many levels of angry patients.

“Somebody might be irritated, or they might be at the other end of the spectrum where they are full out yelling, screaming, and threatening lawsuits,” Baird says. “There’s a lot of latitude when you start talking about the concept of angry patients and managing them.”

And effectively managing the situation is the key to preventing a full-blown event.

Prevention FirstBaird says there are four essential steps to handling patients: Anticipate, Acknowledge, Apologize, and Make Amends.

Anticipate. When you and your staff anticipate a patient’s needs, you’re managing their expectations up front -- preventing a blow-up from occurring in the first place. For example, when patients have blood drawn, tell them that the blood culture takes a minimum of X-number of days to be processed, and that they will be hearing from you as soon as you receive the results. Or, ask patients to phone in on a specific day when you know you’ll have the results.

“You’re managing their expectations up front, so they aren’t going through any undue angst over whether or not the results are ready,” Baird says.

Acknowledge. Suppose, however, that something goes wrong and you forget to phone the patient when the lab results come in? Now you’ve got an angry patient walking into your practice. That’s when you need to acknowledge that he or she is upset, and that you didn’t meet expectations.

Apologize and Make Amends. Express regret that the patient wasn’t called when the lab results came in, and then ask, “What can we do to make this right for you?” Simply listening to them, acknowledging their frustration, and telling them, “We really appreciate your patience and calling this to our attention, because by doing so you’re helping us to improve our processes so this doesn’t happen again.” That could be all that’s needed to make things right. Then, Baird says, use the experience to “make sure that you are improving your processes, because the more you can prevent, the better off you’re going to be.”

Taking the High Road

Scott Glaser, MD, DABIPP, is an interventional pain specialist with Pain Specialists of Greater Chicago. He knows that patients can get angry simply because they’ve been sitting in the office waiting for their appointment -- and now their back hurts even more. But, he says, it’s important to remember that a physician in private practice is also running a business.

“In business, they say that the customer is always right,” Glaser explains. “As a physician, it’s more than that. We have to remember that the patient is choosing to come see us; to let us treat them. In a sense, they are always right, and they’re the ones who have the symptoms, not us.”

Glaser says that one of the most important things for physicians and their staff to avoid is personalizing a patient’s behavior. “They’re not mad at you,” he says. “They want to be taken care of. They’re mad at the situation, and they’re taking it out on you. That’s when you have to be the bigger person,” and remind the patient that you are on his or her side.

An Art and a Science

Baird says that there’s an art and science to managing patients’ expectations and dealing with patients when they’re upset. The science is knowing what steps to take -- the art is understanding when and how to take them. For example, if a patient becomes agitated at the reception desk, don’t raise your voice or admonish the patient for yelling. Instead, say something like, “Mr. Smith, I definitely want to hear more about this issue. Let’s step into a back office where I can take some notes and hear what your concerns are.”

“It’s learned behavior,” Baird says. “You want to make sure that you have people on your staff who have the innate characteristics of being ‘people persons,’ and have the training to know how to handle these difficult situations.”

Glaser echoes those thoughts, and says it’s important for physicians, or department managers, to lead by example. If a staff member apprises you of a situation in the office, explain how you would handle it, then either have the staff member take that approach, or watch as you address the situation. “The most important thing is that staff are caring, understanding people, and that they recognize how important it is for a patient to have a good experience in your office.”