Dealing with difficult patients over the phone

Anna Flaxis, BSN, RN · Mar 8, 2014

When you feel yourself getting triggered and you're not sure what to say, just hear the person out, and calmly tell them "Let me find out what I can for you. I need to put you on hold for just a minute." Then put them on hold and take a moment to compose yourself and think about your response. Write it down if you need to. When you get back on the phone, be very clear about what you can and cannot do for them, but try to sound sympathetic.

Sometimes it can help to ask questions. This can have two effects. One, it interrupts their "venting" process and makes them stop for a minute to think. Two, it can help clarify their situation for you, which helps you understand better and maybe you can be of better assistance to them.

Remember, it is not personal. It is not about you at all. They don't even know you. Navigating the health care system can be extremely difficult, especially for the layperson who doesn't understand all the ins and outs. People get frustrated.

Sometimes you do have to set limits and be firm, but I've found that's pretty rare. Usually if you reassure the person that you understand their concern and that you're taking it seriously and that you're doing everything you can to help them, then they will feel heard and understood and will feel less angry and you might even have a pleasant interaction with them.

Remember, if you feel yourself getting ready to say something out of line, just calmly tell the person you will find out what you can do for them, put them on hold for a minute, and regain your composure.

jadelpn, LPN, EMT-B · Mar 8, 2014

You need to learn not to personlize and internalize. The patients on the phone have no control to "make you mad" unless you allow them to.

If a patient is calling with complaints (hence why you need to blame the MD) then the office manager should field those calls. There is little you can do about those issues.

If a patient calls for refills, then you can only have the MD or nurse deal with those items. If it is your responsibility to deal with it, then you can only say "I will speak with the MD, and I will get back to you if we can refill." Messages on voicemail can also state "medication refills WILL take 24 hours to process the request".

If someone calls because they are still "oh so sick" after starting treatment/meds, you can only have the receptionist make a follow up appointment.

Another thought process is that if a patient is long winded and going on, you could say "I am going to interrupt you here, as this is something you need to speak to the MD about. I am going to connect you to the receptionist, so that a follow up appointment can be made." or "we do not give medical advice over the phone, so you need to make an appointment".

And as the pp suggests, simply saying "I need to find out what we can do for you" is a viable option.

Be sure that your message is consistent--if someone wants a pain med refill, then be sure to say to them "Our office policy is 24 hours to process refills. I will call you when your prescription is ready to be picked up". Do NOT get into an argument about it. Speak camly and consistently always.

twinkerrs · Mar 8, 2014

Also see if your practice will allow you to set limits. Like if you leave your message after 4:00 it will be returned the next day. And maybe refills will be processed in 24 hours and that you will call them if there is a problem if not ask them to check with their pharmacy after 24 hours.

At the clinic I used to work at we told them to have the pharmacy send refill requests even if it was narcotics then we would call them to come get their prescription from us (narcotics)

kungpoopanda · Mar 8, 2014

Dealing with people, especially angry and anoyed ones, over the phone is a skill set of its own that needs to be learned. Can you go to your office manager and ask for some pointers that might start you off or, even better can she point you towards specific training? If there is the facility to record the calls, perhaps she or a trusted colleague could listen to some calls with you and provide some coaching. If it is an area where others are on the phone, you can learn a lot by listening to them and emulating their style. The most important thing about phone work is to remain totally calm and unflustered.

Esme12, ASN, BSN, RN · Mar 8, 2014

Just remember it isn't personal and in a hundred years is this really going to matter? Make all the proper noises. I heard what you are saying. We apologize for any delay. Our policy is...BlahBlahBlah.

Then you let it go.

SHGR, MSN, RN, CNS · Mar 8, 2014

I completely agree with the above posters. You can learn the skills to be better on the phone. Is your manager able to role play with you to figure out new skills?

One thing that really helps me is scripts, writing my own for these situations that arise, and practicing them until they sound natural. Practice modulating your voice. Sometimes speaking more quietly is the answer and that can help de-escalate the patient (and you).

Another technique that has really helped me is reframing the issue and then summarizing at the end, it helps when there are multiple issues. "After we get off the phone I'll call the pharmacy and I should be able to straighten this out for you/I'll forward your message to the doctor/etc;" repeat what the patient is to do; then remind of the upcoming appointment they have. Just being really clear, I think, is the key, so the same message is understood all around.

Also don't feel like you have to solve every (or most) problems, because you can't.

Best wishes.

T-Bird78 · Mar 8, 2014

Our message states to allow 24 hours for calls to be returned and messages left after 4:00 will be returned the next business day, but pts will leave a message, hang up, hit redial, and press 0 to yell at the front desk that their call hasn't been returned yet. We have date and time stamps on the messages so we can tell when they do this. When talking to them get the basics--name, DOB, phone #, pharmacy #, and bare minimum. Yes, some will tell you their life story and that's when you hit the Mute button and lay your head on the desk LOL. If ever in doubt, tell them you'll let the MD know what's going on and will call back with an answer. Can't the front desk forward nurse calls to a dedicated nurse/script voice mail box instead of taking an oral message? If they can't, then have them get just the basics so you can call the pt and get details. It'll be okay.

CapeCodMermaid, RN · Mar 9, 2014

If you can't handle rude/yelling/insensitive/crazy people over the phone, how in the world are you going to be able to handle them in real life as an RN? There is no hold button to push when a family member is in your face yelling, or you have 7 call lights going off and they are all perceived emergencies. You have to learn not to take any of this personally. They have to yell at someone and you're the one they have on the other end of the phone.

NurseGirl525, ASN, RN · Mar 9, 2014

You are in a customer service industry. The people that you deal with are sick and frustrated with being sick. You have to realize a couple of things. First, stop taking it personally. They are not mad at you the person, they are upset with the situation whether it being they are sick and want to get better faster, or something at your office fell through the cracks and they are not happy about it. You are dealing with people at their most vulnerable. That won't change when you become a RN.

Second, put yourself in their shoes for an instant. Why are they unhappy? Is there an issue in the office that can be fixed? You will always deal with angry people but for it to be going on several times a day, I would question if there is a break down in the office somewhere that needs to be fixed. When I call my family doc for refills I understand initially that it will take up to 48 hours. Usually less but I always allow for that, and if there is an issue I speak with the staff in a respectful manner. Most, not all, but most people do this. This why I question what is going on.

Third, you are dealing with people. People are unpredictable, and many are out of control, especially when sick. You need to calmly address their issues and act like you are listening to them and are on their side. That is truly what people want. They want an ally, someone who is willing to listen and not yell back. This is kind of where psych 101 comes into play. Getting angry and frustrated with them, when they are with the situation to begin with is just going to make matters worse. You will quickly become the patients favorite if you let them know you are on their side.

ComeTogether, LPN · Mar 10, 2014

know that it's not just you, and it's not just the medical field. It's everywhere. People can be total A-Holes. Some things that helped me......

First, paraphrase their problem and repeat it "Ok, Mrs. Jones. So you were trying to get in the shower and you slipped on your bathmat, is that right"? This way you clear up any misunderstandings right away.

Second, apologize. Even if you didn't do it, even if they are way off base. "I am so sorry this has happened to you" "I am so sorry you feel this way". Obviously, never admit guilt for something you didn't do, but just make them think you are sorry. Sometimes all the person wants is someone to listen.

Third, like others said, put them on hold or call them back when you can think the problem and solution through. "Ok Mrs. Jones, I understand you slipped on your bathmat and your dog ate your script for Oxycontin, so you need a new one now. I'm very sorry to hear that! Let me speak with your nurse/doctor/psychiatrist/whatever and I'll give you a call back"

Mrs.LaDuke09 · Mar 10, 2014

I really appreciate everyone's input on this. I feel a good nurse is one who can admit they have faults and ask for help fixing them I have made myself a little check list of some of your idea's and wording that ill keep in my draw at work.