ADOC 510402

THERAPEUTIC
COMMUNICATION AND
COUNSELLING
Management Of Angry Patients
What Is Anger?
•Anger is a negative emotional state that is
generally accompanied by physiologic
arousal and antagonistic thoughts
directed toward a person or object viewed
as the cause of an adverse event.
(Encyclopedia of Mental Health)
Anger is a NATURAL,
instinctive response to
threats
 We all get angry
Anger come in a
range of strength,
from mild irritation ,
to frustration, all the
way to fury and rage
Learning Outcome:
1) Identify what infuriates patient and/or family
2) Identify early signs of anger
3) Apply the strategies in dealing with angry
patients
•Angry patients & family biggest challenge

•Tense emotion

Calm? Professional? Empathetic?

Learning Outcome:
1) Identify what infuriates patient and/or
family
What trigger……
Anger???
 What Infuriates Patient And / Or
Family
•Person

•Medical staff?
•Own self?
•Family members?
 What Infuriates Patient And / Or
Family
•Situation
•Diagnosis

•Bad outcome
•Medical error
•Long waiting times
•Unresponsive staff or providers
•Stress – family problems, financial issues
 What Infuriates Patient And / Or
Family
•Listen to patients’ stories
•Anger may result from frustration

Our curiosity about what has happened

has a therapeutic effect
Satir, V., Banmen, J., Gerberm J.
& Gomori, M. (1991). The Satir
Model: Family Therapy and
Beyond. Palo Alto, CA: Science
& behavior Books, Inc.
Learning Outcome:
2) Identify early signs of anger
Anger Symptoms
1) Physical
2) Emotional
Early warning signs

•Irritable comments
•Sighing
•Agitation
 Anger Physical Symptoms
•Increased BP •Slightly opened mouth
•Increased HR •Facial flushing
•Tingling sensation •A tense jaw
•Muscle tension • Adopting an aggressive
stance
•Glowering eyes
•Knitted brows
•Pursed lips
Anger Emotional Symptoms
•Irritability

•Frustration

•Anxiety

•Rage

•Stress

•Feeling overwhelmed
•Guilt
Anger Expression

1) Outward
2) Inward
3) Passive
Outward Anger Expression

• Obviously express anger

•Shouting

•Cursing

•Throwing or breaking things

•Being verbally or physically abusive
Inward Anger Expression

•Directed at himself / herself

•Negative self-talk
•Denying things that make he / she happy
•Denying basic needs
•Self-harm

•Isolating
Passive Anger Expression

• Subtle and indirect ways to express anger

•Giving silent treatment
•Sulking

•Being sarcastic
•Making snide remarks
 6-pronged Continuum Of Anger
1) Calm and nonthreatening: A patient may
be frustrated but fail to show overt signs of
agitation.
2) Verbally agitated: A patient may say,
“This is ridiculous. I can’t believe I have
been sitting in here for 45 minutes,” as he
or she paces while waiting for a physician
who is running late.
 6-pronged Continuum Of Anger
3) Verbally hostile: A patient may shift from
offering phrases of discontent to unkind
phrases,
❑eg, “This doctor is incompetent and this entire
practice is a sham.”
4) Verbally threatening: A patient may demand
an apology or threaten to sue.
 6-pronged Continuum Of Anger
5) Physically threatening: A patient may take a
fighter’s stance and make a fist.
6) Physically violent: A patient may attempt to
injure providers.
Anger Signs
 Early Signs Of Anger
•A rapid heartbeat
•Faster breathing
•Tension throughout the body
•Restlessness, pacing, and tapping of the feet
•Clenched fists and jaw
•Sweating and trembling
Learning Outcome:
3) Apply the strategies in dealing with
angry patients
Video 1
Video 1

1) What makes the patient angry?

2) What might trigger the situation?
3) What do you think of the situation?
4) What should you do in that kind of
situation?
Strategies In Dealing With Angry
Patients
1) Pause & be attentive
•Remain calm - Speak slowly and clearly; relaxed
posture
•Active listening - Acknowledge the patient’s
anger, let patient diffuse the emotion;
Strategies In Dealing With Angry
Patients
2) Avoid being defensive
•By arguing or expressing opinions before
letting patients finish their stories power
struggle augment anger
•Thank the patient – for pointed out
‘shortcoming’
Strategies In Dealing With Angry
Patients
3) Stay curious about patient’s story
•By staying curious avoid being defensive
about ourselves

Our curiosity about what has happened has a

therapeutic effect
Strategies In Dealing With Angry
Patients
4) Acknowledge the difficulty of the interaction
• Being aware of the tension
• Identify the barrier
• Acknowledging with the patient that there is
difficulty
Strategies In Dealing With Angry
Patients
5) Find out the specifics of the story
• Encourage the patient to give the details
• Often there are other emotions / situation
behind the anger
Strategies In Dealing With Angry
Patients
6) Express empathy for the patients
• Acknowledgement and appreciation of
someone else’s emotions
• Feel cared about and listened to
 Strategies In Dealing With Angry
Patients
7) Make a statement guessing at the meaning
behind the patient’s anger and validate
Strategies In Dealing With Angry
Patients
8) Take an action on patient’s behalf if possible
• Be an advocate

• Apologies if an error has occurred

Strategies In Dealing With Angry
Patients
9) When possible, link the patient with the
resources that can help
Strategies In Dealing With Angry
Patients
10) Transition the feeling
Strategies In Dealing With Angry
Patients
11) Remain at a safe distance
• When anger turns violent
• Assess risk in advance
Strategies In Dealing With Angry
Patients
12) Be sensitive to non-verbal communication
Strategies In Dealing With Angry
Patients
13) Soften request
• Please…
• Encourage questions/solutions
 Rationale & Useful Phrases
Behavior Useful Phrases
Pause and be attentive “Tell me more about
•Avoid being defensive what’s upsetting you”
•Stay curious about the
patient’s story

Acknowledge the difficulty “Having to wait for 1

of the interaction hour to see me is
really a long time”
 Rationale & Useful Phrases
Behavior Useful Phrases
Find out the specifics of the “It’s very frustrating
story to have to wait for so
•Encourage the patient to long”
give the details

Make a statement guessing “Was it frustrating

at the meaning behind the because it was a waste
patient’s anger and validate of your time”
 Rationale & Useful Phrases
Behavior Useful Phrases
Take an action on the “I’ll see what caused
patient's behalf if possible the delays today.
•Be an advocate Maybe it’s something
that can be avoided in
the future”

When possible, link the “Would you like to

patient with resources that register a complaint?”
can help
 Rationale & Useful Phrases
Behavior Useful Phrases

Transition the feeling “Well, now that you

finally got to see me ,
what can I do for
you?”
Video 2
 Conclusion: Strategies In Dealing
With Angry Patients
1) Allow the patient to vent their anger.
2) Acknowledge the anger ‘I can see you are
really angry about this.’
3) Validate the anger ‘understandably you are
very angry as this is a very frustrating situation
you are in.’
4) Offer to explore the situation in more depth – it
is often found that there are many layers to the
an-ger and frustration the patient is
experiencing.
Questions