Managing difcult situations

Negative outcome
Janet Smith storms in, extremely angry, and goes to the nursing station demanding to know
“What the hell have you done to my mother?” Her elderly mother, Gladys Parker, who is
sleeping, has a large wound on her head following a slip on the ward. The nurse on duty,
Kate Jones, is immediately defensive, which shows in her attitude – both body language and
tone of voice. She is tired and wants to go home after a long, stressful shift and has been
taking good care of Mrs Parker following her fall. She feels that Mrs Smith is extremely rude
and the two women clash. Mrs Smith makes a complaint about her mother’s fall and about
the nurse’s attitude.
 Refection
 After observing or dealing with a challenging scenario, take time to refect:
 Did the difcult situation appear to come from nowhere?
 Were there any warning signs?
 What have you learned?
 What could have been better?
 What might be done diferently in the future?
 How did you feel?
 Was it a good outcome in the circumstances?
 Tips on managing difcult situations

 Recognise that it is human to have feelings and emotions

 Do not lose your temper; raise your voice; get angry, sarcastic or provocative; or
attempt to humiliate the aggressor
 Take a deep breath, relax, and remain calm, neutral and respectful
 Do not react and start disagreeing: pause and think before acting
 Say “No” to unreasonable demands, but be prepared to manage any adverse
reaction
 Do not tell the person that you know how they feel but do try to see the situation
from their perspective
 Show warmth and empathy
 Do not let a bad experience with one person afect your whole day/shift or your
family life – keep a sense of perspective and a professional attitude
 Mrs. Washington had a vaginal yeast infection. She was prescribed
medication and told by the doctor to take it with yogurt because it
would help with the yeast infection. When Mrs. Washington went in for
her follow-up appointment, a strawberry was found in her vagina during
the vaginal exam.
 Zakiyah is a care worker. During a team meeting, Catherine, one of the care
workers in Zakiyah’s team, talks about a person she is supporting. Catherine
says that she is worried that a person she works with, Bert, is being ‘taken
advantage’ of by his son. Catherine says that Bert never seems to have any
money but she thinks that Bert’s son is taking about R1000 a week of him. She
suspects that Bert’s son is a drug user (as she has heard rumours about this in
the local community). She asked Bert about this one day and he told her to ‘get
her nose out of his business’. Jane is really worried she has ofended Bert and
since lots of her concerns are based on rumours, she is not sure what to do.

 What issues are there around confdentiality here?

 ■ What are some of the dilemmas Catherine is facing?
 ■ What should Zakiyah advise Catherine to do?
 Patient: My dog might not get fed today because I'm in the hospital.
 PHYSIOTHERAPIST: I understand how worried you are for your dog. Is
there a friend or neighbor that you can call on the phone from here and
talk to about feeding your dog?
 What non verbal cues can the physiotherapist show in this discussion to
show his/her concern about the patient?
 You observe a confrontation at the desk area, where a physical therapist
has just reprimanded a nurse in front of others for not having toileted a
patient prior to her scheduled time to go to physical therapy. The nurse
is upset and embarrassed because she had been busy with an
emergency. She later states that she has experienced this side of the
therapist before. She decides it is not worth discussing with him because
he never listens anyway.
 Good morning Mrs Mawela. How are you today? Did you get a good
sleep? You look rested. Are you ready for your therapy session? You look
nice and bright.

 What can you say about this communication scenario?

 https://youtu.be/5i1cWqAABb8 ( medicine)
PROBLEMS
 First of all, he is not dressed professionally. Patients expect a degree of
professionalism that begins with your choice of clothing.
 This doctor starts of poorly. He does not introduce himself properly or
shake hands. In fact, the patient has to clarify this by asking, “Are you
my doctor?”
 The doctor then makes an incorrect assumption about the relationship of
the person sitting next to the patient and creates an uncomfortable
experience for the family member.
 He also interrupts the patient while speaking and ignores his concerns.
In fact, he appears to be oblivious to the fact that the patient and
his sister are upset about the time delay and does not feel the need to
properly acknowledge or apologize for the wait. Instead he crosses his
arms to signify that he does not want to hear such a complaint. In
addition, he does not even give a time estimate of how long the X-ray
will take despite the patient requesting it.
 Lastly he bad-mouths another doctor in front of the patient, further
demonstrating a lack of professional decorum.
 You are a junior doctor on a ward with a very sick patient who has been
waiting for the results of several tests and scans to come back. The
results arrive but you aren’t able to tell the patient her results until the
Registrar arrives, and he has been held up and will be late. Upon hearing
this, the patient becomes angry and insists that you tell her what her
results are.
 A woman attends the emergency department with her 18-month-old
child, who has a cough. She states at the outset that she wants a
prescription for antibiotics.The exam reveals a healthy-looking child with
an occasional cough, no fever, and an otherwise completely negative
exam. The doctor explains this to the mother, and says that antibiotics
are not indicated.
 The mother becomes angry and insists that her child needs the
antibiotics. Other modalities for treatment are suggested, but fnally the
mother says she will sue the doctor and have his medical licence
revoked. She refuses further examination or assessment by a colleague
and storms out. The doctor writes a note in the medical record.
Ms. Jackson, a 37-year-old patient, was told by the
doctor to clean, pat and cover her wound with a
disinfectant cleaner. She went home and cleaned
the wound with household bleach and used toilet
paper, napkins and old rags to cover the wound.
After cleaning the wound with the bleach, Ms.
Jackson suffered a second degree chemical burn and
developed an infection.

How could communication between the patient and

doctor be improved?
Fatima went to the clinic because she was having
dizzy spells. She said she knew she had high blood
pressure because she had the same symptoms as her
husband. In the assessment, the medical assistant
(MA) asked, “Are you taking any medication for
your high blood pressure?” The patient said she
had been taking her husband’s high blood pressure
medication from Mexico. After the examination, the
physician determined that Fatima did not have high
blood pressure. The dizziness was due to taking the
medication that was not prescribed to her.

How can you encourage your patients to be open

and honest about the medications or treatments that
they are taking?
 The nurse was training Mr. Maleka as he was being
discharged. Mr. Maleka had gangrene on the toes of
his right foot. On his left foot, all of his toes were
amputated. The nurse asked, “When did your toes
get amputated?” Mr. Maleka replied that when his
toes had gangrene and they shriveled up into sticks,
he got a pair of scissors and cut them off himself.
He said, “I did not bleed to death, but my foot got
infected because I left my cut open, so it got maggots
inside.” The nurse realized that the maggots probably
had eaten the dead tissue off his toes. He told the
nurse he never went to the doctor because he had no
money and was afraid they would cut off his leg
 How could the healthcare professionals encourage
Mr. Maleka to seek diabetes education?
 Mr. Gallo, a Spanish-speaking patient, visited the
clinic for his routine appointment. During his exam,
the physician noted that the patient’s eye pressure
was above normal. Mr. Gallo informed the provider
that he was currently using two glaucoma eye drop
medications. The attending provider prescribed an
additional eye medication to lower his eye pressure.
During the discharge process, Mr. Gallo and his
wife were asked if they understood the medication
instructions. Both nodded their head yes. At the next
appointment, Mr. Gallo stated he was only taking
one eye drop prescription. He thought he was to
discontinue the other two eye drop medications.

 What are some techniques that can be used with Mr.

Gallo to promote effective communication?
 Since Mr. Gallo has two eye drop medications,
what measures could be taken to ensure that he
understands how to use the medications correctly?
Rose, a 19-year-old patient with diabetes, had just
moved to South Africa from Mozambique. She was
being evaluated by an ophthalmologist for a twitching
eye lid. Rose was told that the twitching could be
due to stress. She was also diagnosed with myopia
(near-sightedness). Rose was told by the provider to
buy a sports drink to help with the stress. During the
eye examination, Rose asked the doctor how she was
supposed to put the sports drink in her eye.

What is one of the first things the healthcare

professional should do when finding out that the
patient was from another country?

What could have been done differently to teach Rose

about understanding how the sports drink could have
helped with her condition?
 Physicians have a professional responsibility to stay above the fray:
 Keep calm.
 Explain the facts and situation rationally.
 Ofer possible solutions.
 Do not try to intimidate the patient or allow yourself to be intimidated.
 Consider asking your supervisor or a colleague to help defuse the
situation.
 If there is no way to resolve the issue, end the interview politely.
 Record the facts objectively and without emotional language.