Tips for Handling Upset Patients

Elizabeth Kohout, MSN, RN

I’m the charge nurse at an ambulatory care clinic. My job includes triaging our walk-in patients and speaking to patients when they say they want to see a manager. This means I see a lot of patients who are angry that their provider is running behind, upset because they feel like their concerns are being overlooked, confused about their plan of care, or scared about their health. Here are some things that help me navigate these situations.

1- Keep your safety front in mind

Before going into a room, I always ask a few questions to gauge how upset the patient is so I (hopefully) have some idea of what I’m about to walk into. I also always—no matter how busy I am-- check their chart to see if there’s an alert for past abusive or aggressive behavior. Finally, I try to position myself between the door and the patient so that I can’t get trapped in the room. This isn’t possible in all of our exam rooms, but, after once having a patient block the door so I couldn’t leave or reach the phone, I definitely always have an escape strategy.

2- Introduce yourself

Although it may be obvious to us, patients may have no idea who they’ve been speaking with—medical assistants, doctors, case workers, and administrators can all blur together in a confusing alphabet soup of titles. When I enter a room, I always introduce myself with my title and tell them that I understand they’ve made a complaint, have a question, etc. This lets them know who I am and that their requests are being taken seriously.

3- Sit down

I always, always sit down to speak to upset patients. Myriad studies have shown that this simple act dramatically improves patients’ perceptions of their care.

4- Remember that it's okay for patients to be upset and to express their feelings

Most patients I speak to are justifiably upset. I’d be upset too if my provider were running behind, my appointment was rescheduled, or I felt disrespected by clinic staff. It’s also normal for people who have just received bad news about their health to have an emotional reaction. A lot of patients just need someone to hear them out, and I’ve been surprised by often the simple act of letting someone vent for a minute or two will resolve whatever issue they’ve raised.

That said, if the patient begins yelling or becomes verbally abusive, it’s important to set some boundaries. I’ll usually interject with something like, “I understand you’re upset, but I am noticing that you’re using foul language/ starting to shout/ etc. I’m here to help, and I have some ideas for what we can do, but to share them with you, I need us to maintain respectful communication. Can you please lower your voice?” Every once in a while, this causes someone to storm out of the room (obviously not a great outcome), but usually, people are able to check themselves, and we can continue trying to resolve the situation.

5- Apologize if you’re in the wrong

If the patient has been inconvenienced or disrespected, acknowledge that they were wronged and apologize. It never ceases to amaze me how much a simple, sincere apology can help diffuse a tense situation.

Caveat: If a patient is upset because they believe anything even vaguely resembling a medical error or malpractice has occurred, I know that’s above my pay grade and call my supervisor immediately.

6- Be honest

Sitting down with the patient, hearing them out, and offering a sincere apology all build trust and rapport. The fastest way to erase that trust is to promise something you can’t deliver. If I can’t do what the patient is asking, I explain why I can’t do it and what I can do instead. Not everyone reacts well to being told no, but patients can tell when you’re lying, and most people respect honesty. If I don’t know what to do, I tell them I’m not sure how to proceed but that I have a few ideas for how to help. I also explain that it will take time for me to follow up and give them a rough time frame (15 minutes, before lunch, by Thursday, whatever) for getting back to them. I then make sure I follow up within that time frame.

7- Don’t take it personally

Sometimes I feel myself getting defensive because the patient is abrasive or I know they’re in the wrong. When that happens, I try to focus on my breathing for a few seconds so I can calm down and avoid escalating the situation.

8- You can’t win them all

You’re never going to be able to fix everything for every patient. Some patients will come in with an ax to grind, and there’s nothing you’ll be able to do to make them feel better. Some will be incredibly unpleasant, no matter how kind, competent, and accommodating you are. We don’t always know what’s going on with patients outside of the clinic, and their anger or grief may have nothing to do with you or the care they’ve received. All you can do is your best.

If you have more tips for managing upset patients, I’d love to hear about them!