How to Handle Patient Confrontations

Oh, no, here comes Mrs. Baker, and she looks irritated. She was furious on the phone yesterday when I told her that the doctor wouldn't renew her prescription without an exam. And now she's been in the reception area for 25 minutes because the doctor was called away for an emergency. I've been watching her out of the corner of my eye, and she's about ready to blow. The office manager is at lunch, the waiting room is full … what am I going to do? 

Ninety-five percent of your patients are a dream to work with. They are easy-going and cooperative with the practice's policies and procedures that ensure efficiency and quality patient care. On occasion, however, things can go very wrong and patients become angry, stubborn, manipulative, and even abusive. Some people are ready for confrontation while others avoid it all costs by hiding, giving in to strong demands, or finding someone else to handle the problem. How do you handle confrontational patients? 

Recognize Your Weaknesses  

The human body reacts quickly to challenge, and the natural tendency is to fight or take flight. So the first step in managing a confrontational situation is to recognize your personal physical and emotional reactions and then take steps to get them in check. Do you become flushed or begin to cry? Do you avoid eye contact and begin to make excuses, or do you lose your temper quickly or get sarcastic and nasty right back? Ask your family and coworkers for some feedback so that you can take proactive steps to improve your communication style.

Verbal Communication Techniques  

If you communicate in ways that show empathy for and understanding of a patient's situation, you will stand a better chance of reducing tension and resolving problems, even if you disagree with the patient's point of view. Try this three-step assertive response to take control of the situation.

1. Wish I Could . This phrase is an empathic way to say "no." Use it with a sincere tone of voice to let the patient know that you really would like to help, but you can't. "I wish I could do that for you, Mrs. Baker, but our policy is very clear."
2. Agree in Principle. Rather than argue over an issue, use this technique to acknowledge that the patient's point of view is possible, and then present what you are willing or able to do. "I can understand how you might see it that way. …" This technique not only shows empathy for the patient but also validates your understanding of the complaint.
3. Broken Record. This technique is most effective with patients who keep trying to get you to do something their way. Your response is to stay firm, use a calm tone of voice, and repeat over and over what you are willing or able to do. Don't waste time coming up with new excuses or reasons why; this just engages the patient in an argument and suggests that the policy can be changed. Simply repeat your position politely and calmly. This technique is particularly effective with patients using abusive language, whether in person or on the telephone. For example:

• "Mrs. Baker, with this particular medication, the doctor requires patients to come in for a checkup before a refill. Is 2 pm tomorrow a good time?"
• "Mrs. Baker, I know it would be easier for you to just get a refill, but it is very important that the doctor check your condition first. Will 2 pm work for you tomorrow?"
• "Mrs. Baker, I know this is frustrating you. If you can just come in tomorrow, you'll be able to talk to the doctor about the need for a refill based on your condition. Why don't I put you down for 2 pm?"

Tips for Nonverbal Communications  

• In a confrontational setting, your tone of voice should become slightly firmer and deeper, not necessarily louder.
• Be careful to keep a calm, businesslike tone even though it is very easy to be sarcastic or patronizing.
• Keep direct eye contact with the patient and a straight posture. This adds to your credibility.
• Put yourself at the patient's eye level. If the patient is standing, stand up, or if the patient is sitting, sit down. Also, if you are much shorter or smaller than the patient, you may appear to be at a physical disadvantage. Asking the patient to sit down with you reduces that difference.
• If possible, move an angry or disruptive patient to a private office so that other patents and staff are not disrupted.
• Asking the office manager to join you or take over the problem may be an option, but always use the situation as a learning experience so that you will be able to handle similar problems on your own. Remember that solving patient problems is part of your job, so learn to be an expert!

If you need help with customer service in your practice, a TMA consultant can perform customer service training for your staff.  For more information or to request a proposal contact TMA Practice Consulting at (800) 523-8776 or email us at practice[dot]consulting[at]texmed[dot]org.

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