Managing Difficult Interactions with Patients
By Dennis Boyle, MD
Studies suggest that between 10–20% of patient visits are described as “difficult” by physicians, and with the pandemic, the incidence seems to have increased. Examining how to navigate these types of situations is important for a variety of reasons:
Patient satisfaction is now a frequently measured parameter and poor interactions may lead to negative feedback that does not accurately reflect the medical care provided.
Personal satisfaction on the part of the provider is also an issue, and difficult situations can leave a provider confused, angry, and frustrated, and contribute to burnout.
If the patient interaction is sidetracked into a contentious discussion, important parts of the clinical history might be missed.
Increased legal issues are seen in physicians who have frequent difficult interactions as medical board complaints or threats of lawsuits may result.
Focus on Determining the Cause of Conflict
Clear communication is essential when there is conflict or misunderstanding. It can be useful to differentiate between complaints (e.g., difficult breathing) and concerns (e.g., wanting a certain medication) and then explore the patient’s understanding of the issue. If the interview becomes argumentative, one needs to have a clear understanding of why the patient is angry, upset, or concerned.
Although a difficult interaction may be inevitable, deescalating it early is vital. Often the patient starts a difficult encounter with a high emotion, such as anger or sadness. Physicians need to recognize this and not let their own emotional response escalate the situation. Care should be taken to not take conflict as personal. The challenge is to remain calm, objective, and focused on how best to respond to these situations.
Identifying and acknowledging a patient’s concerns and letting them discuss what their beliefs are may help calm him or her down. We need to understand the behavior of the patient in the context of their conditions. If one can understand where the anger is coming from (e.g., fears, past experiences, misinformation), one may find the path to de-escalate the situation.
Tips for Constructive Interactions
Active Listening
Physicians should listen in an open and attentive manner. Be careful of your own body language when tensions are high. Any probing should be done in a mild or respectful way. Patients should be able to express themselves and the physician should listen and seek to understand their perspective.
Reflective Listening
Repeating statements back to the patient in a summarizing fashion is a wonderful way of really hearing what the patient has said. This also builds empathy as the patient realizes you have heard him or her with phrases such as “I hear that you believe strongly that this medicine will help you…”
Acknowledge the Emotions
Using succinct statements like “I can see you’re upset” helps reflect the emotion you are seeing to the patient. This builds empathy and rapport even in a difficult situation. The patient can tell you are listening and may realize how their own emotions are impacting the interaction.
Build a Win-Win Partnership
Let the patient know that you want to work with them with a focus on a treatment plan that is appropriate with statements such as “Let’s act as a team and monitor your symptoms closely” or “I will help you through this situation and we will work through this together.”
Recognize that it May Take Time
Behavior modification is not instant, and it may take time to convince patients to change their behavior or follow your advice. Understand that in these situations you may never convince the patient to do the right thing. And change is internal in the psyche of the patient.
Dennis Boyle is with the COPIC Department of Patient Safety and Risk Management