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Anger, Hostility and Frustration...Oh My!
Dealing With Difficult Patients

Clint Maun, CSP

“Life is pleasant. Death is peaceful. It’s the transition that’s troublesome.”
—Isaac Asimov

Rage. It’s everywhere. Get in your car, and you’re bound to experience “road rage". Ride in a plane and you might fall victim to “air rage". Think you’re safe at the workplace? Think again. A computer failure or sly comment by a co-worker could cause one to go into a bout of “desk rage". It appears that Americans are growing angrier by the second. And adding to the long list of trendy terms that detail our tantrums is “ward rage".  It’s the phrase coined to describe the epidemic of anger and frustration in healthcare facilities.

Angry Patients...
What’s Causing It?

Perhaps the first question that pops into the healthcare professional’s mind is, “Where is all this anger coming from?” Quite simply, there is no “one-size fits all” answer but there is a body of evidence that points to some plausible causes. According to the American Journal of Nursing, patient and family complaints have been increasing since the staff downsizing and restructuring of the mid-1990s. When a facility’s staff is spread thin, patients might feel that they are not receiving enough personalized attention. This anger can be further fueled by the patient’s feelings of vulnerability as they deal with standard routines, intrusive procedures, and the reality that their health is in jeopardy.

Other possible causes of patients’ anger include unrealistic expectations. Many patients imagine their caretaker to be a saintly angel, and are sorely disappointed when he/she fails to live up to that expectation. Difficult and pushy behavior can also emerge when patients feel their own unique situation has been ignored. Don’t forget that anger can also be a legitimate response by a patient whose needs are not being met.

Couple all of the above with time pressures, heavy workloads, and the anxiety of dealing with life and death situations and you’ve got the recipe to produce scenarios in which anger of both staff and patients is readily evoked.

As welcoming and inviting, as ’going off’ on a patient may seem, the healthcare professional must keep his/her cool at all times. Now that you have a better handle on the reasons for difficult patient behavior, below are some strategies to help you cope.

Listen Before You Label

Most patients don’t intend to be difficult, so try to avoid labeling them as being ’demanding’ or ’pushy’. While negative feelings toward such patients are understandable, remain calm, speak softly, and help the patient to discover why he or she is angry.

Be Clear and Sincere
Oftentimes, the natural reaction to anger is a defensive one, which can make a patient feel even more frustrated and irate. For example, if a patient has had to wait a long time to see the doctor, it’s not going to make him or her feel better when the healthcare professional says, “Everyone else has been waiting. There’s nothing I can do.” Instead, staff should be sincere and apologetic to those who have had long waits. It’s also important to give patients options, such as suggesting better times for appointments to eliminate waits in the future.

Also, make policies clear with new patients. Let them know everything from the procedure staff performs when evaluating a patient to how quickly phone calls are returned. This will help reduce unrealistic expectations—a patient is going to be less likely to get angry at a 30-minute wait, if they know that this is the standard.

Empathize, Empathize, Empathize
Try and remember that most patients are in a predicament. The fact that one’s health is not 100% is enough to make anyone cranky. Simply recognizing and understanding your patients’ concerns can significantly improve the situation. Keep in mind that the healthcare facility might be intimidating and scary to an already vulnerable patient. Ask open-ended questions, such as “What would make you feel better?” in an effort to identify the patient's real problem. Maybe they’re embarrassed of their condition, are nervous about medical costs, or were treated poorly elsewhere.

Set Limits

Sometimes, even after doing all that can possibly be done, a patient will still remain angry, overly demanding and pushy. At these times, it’s best to set limits. For example, saying, “There are other patients that I need to attend to. I will return to check on you in 15 minutes,” is a good way to keep control of the situation, while still taking care of the patient’s needs.

Don’t Let It Get Under Your Skin
At some time or another, healthcare professionals are just going to have to face it: if you want to survive in this profession, you better grow some thick skin. Part of what makes healthcare workers so special is their ability to stay calm and professional under the most hectic situations. That being said, a professional might as well quit all together if he/she is going to get bothered by every difficult patient.

If you feel that a patient is testing your limits and you might lose control, take a break. Kindly excuse yourself from the room and allow yourself a few minutes to cool off—this is not only healthy for you, but for the patient as well. Lastly, use consultants in your facility, such as a psychiatric liaison nurse, social worker, psychologist, or chaplain if you are at your wit's end in dealing with an angry, demanding patient.

When Difficult Escalates to Dangerous
Healthcare professionals today work in a world where violence is all too common. Workers often describe hospitals and healthcare facilities in war-like terms and metaphors. “Time to go to battle", “It’s a jungle out there,” or “I was getting flak” might be commonly heard phrases. Perhaps these military-like terms are frequently used because the healthcare profession is highly prone to violent situations. In fact, hospital workers suffer non-fatal assaults at more than four times the rate of private sector workers. There is always a chance that a patient’s or family member’s anger could escalate to violence. That’s why it’s critical that you and your staff are aware of the warning signs and are prepared for the possibility of violence in the workplace. Below are some key factors that can place healthcare professionals at risk.

Risk Factors For Healthcare Workers

  • Low staffing levels
  • Isolated work with patients during exams/treatments
  • Dealing with patients who are involved with drugs or alcohol
  • Facilities that are utilized by police and others for violent criminals or mentally ill patients
  • Lack of training among staff
  • Long waits in ER rooms, waiting rooms, etc.

The Occupational Safety and Health Act guarantees all workers the right to a “safe and healthful workplace.” Your employer must provide a safe workplace, using written policies, employee training, proper staffing, and follow-up of any incidents. Furthermore, employers may be penalized by the Occupational Safety and Health Administration (OSHA) for neglecting to reduce the potential for violence.

Contact an OSHA area office (or via the web: http://www.osha.gov) for help or more information on safe workplaces.

If you would like more information on this topic, please click one of the following:

We’re in the People Business I

We’re in the People Business II

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The Normative Aging Study
American Journal of Nursing, 96(11), 25-39
The Knoxville News-Sentinel, May 7, 2001
The University of Arizona: Workplace Violence Prevention