Addressing Patient Anxiety

In a medical office environment you will meet many types of people. You will often encounter people who are experiencing a variety of uncomfortable emotions, including uncertainty, embarrassment, shyness, or fear. Virtually every patient contemplating medical treatment experiences some degree of anxiety. This anxiety can quickly change to hostility and anger if he or she encounters unfavorable circumstances. Often, you are dealing with a frightened patient who is using anger to gain control of the situation. Regardless of the true cause, the anger will be focused on the most convenient and visible target — and that could be you.

When faced with someone who is upset or angry, it is best to remain silent and to let that person tell you about the problem. Respond with noncommittal comments, such as “yes,” or “uh-huh,” until the emotionally charged patient has calmed down. This technique of attentive silence often defuses angry people. Once the angry speaker has finished expressing dissatisfaction, calmly ask him or her to reiterate part of the message, even if you fully understood it. Requesting additional information or explanation reinforces the importance that you attach to the message.

One of the worst errors you can make in dealing with angry or dissatisfied patients is to try to avoid them. Although such a reaction is understandable, avoidance is the surest way to hasten a patient’s visit to the attorney.

As difficult and stressful as it may be, if you must deal with an angry patient, keep your wits about you, and do not take risks that could cause harm to you or others.

Tips

• Don’t argue with or provoke a hostile person. Avoid staring, which could be interpreted as being confrontational.
• Be reasonable and realistic about the situation. For example, provide honest reasons for any delay.
• Keep at least two or three arms’ lengths away from a hostile person.
• Use a firm tone of voice.
• Listen to and acknowledge his or her concerns.
• Separate the hostile person from others if possible.
• Develop an emergency code to alert other office staff that a violent person is on the premises.
• Summon help immediately if a patient or visitor:
  
  • talks or complains loudly,
  • uses profanity or makes sexual comments,
  • demands unnecessary services,
  • paces in the waiting room,
  • states that he or she is going to lose control,
  • appears tense and angry, or
  • appears intoxicated or under the influence of drugs.

Patients under stress can exhibit a variety of behaviors. Such behaviors are exhibited when a patient appears irrational and/or self-demeaning. A patient under stress could appear to have sociopathic tendencies or be manipulative and medically noncompliant. If anything goes wrong, more often than not, it happens with patients who are displaying these behaviors.

Irrational behavior is difficult to address. You cannot reason with irrational thinking. Often this occurs when one’s expectations are not being met.

Tips

• Learn to recognize this type of behavior in a patient ahead of time.
• Try to meet appropriate expectations and bring inappropriate expectations in line.
• Document the encounter thoroughly.

Self-demeaning behavior is often exhibited through inappropriate apologies. For example, someone apologizes to you for an adverse outcome or for bothering you when he or she needs something. The problem with self-demeaning behavior is that it often gives mixed signals and is sometimes hard to read. Self-demeaning behavior might be indicative of a person who is just easy to deal with, or one who needs emotional support, or it could mean the behavior is a disguise for passive-aggressive behavior.

Tips

• Be supportive, but do not encourage the behavior.
• Repeat instructions to ensure patient understanding.

Sociopathic behavior can be easily recognized. It is often displayed in interactions that are manipulative, untruthful and forceful when faced with an adverse outcome.

Tips

• Manage with firmness and strength, not with anger.
• Let the patient know that threats of litigation, etc., do not intimidate you.

Pushy behavior tries to push you or office staff into decisions that go against your better judgment and is dangerous from a litigation perspective if anything goes wrong.

Tip

• Stand firm, use logical reasoning and thoroughly explain your decision.

Often, noncompliant behavior is not seen as a problem behavior. But this can be dangerous from a litigation standpoint. It could lead to the shifting of blame from the decision maker to others for choices made.

Tips

• Be very clear as to the consequences of noncompliance.
• Document noncompliant behaviors, put the warning in writing, and include the patient’s signature when applicable.
• Know when to end the physician-patient relationship. (The Doctors Company can assist you when patient termination is necessary.)

Dealing with stressful situations will test your patience and ability to communicate. It is important that you do not let your own emotions or frustrations interfere with your knowledge and objectivity. Remember, a confident and caring attitude, consistency, and a reassuring smile are indispensable ingredients for solid positive rapport.

Tips

• Don’t be afraid to tactfully express reasons for your actions and recommendations.
• Be a good listener.
• Be aware of body language and verbal congruence.
• Do not avoid or ignore inappropriate behavior.
• Do not lose your temper.