10 Ways to Stay Calm and Clearly Communicate With Difficult Patients

Christine Lehmann, MA

November 19, 2021

Busy doctors may not want to spend the time to delve into why patients are upset or resolve conflicts, but it's time well spent, according to one expert.

Patients can get upset over long waits to see their doctors or over the cost of a procedure. During COVID, some patients get angry when they're asked to wear masks or when they are told that they can't accompany a pregnant friend or spouse into the exam room.

How do you handle these tough situations without making them worse?

"It's important to understand that challenging patients rarely see themselves as challenging, and from their perspective, they're just reacting to a challenging situation," said Natalie Y. Howe, director of marketing and sales support for GetixHealth, LLC, at the Medical Group Management Association (MGMA) 2021 Annual Conference.

Natalie Howe

Oftentimes, said Howe, there is something else going on, from worries about something going wrong to a bad interaction with a member of the staff.

To better deal with patient emotions, she shared her 10 strategies for resolving conflicts.

1. Listen intently.

A physician walks into the exam room and the patient says, "I can't believe you made me wait this long!" The patient's arms are crossed and her body language indicates she's tense and upset.

In this scenario, stop multitasking for 2 minutes and turn and face the patient and ask, "Do you mind telling me what's wrong?"

2. Show them you're listening.

Since body language is about 87% of communication, keep eye contact and nod your head when listening. Validate what the patient is saying with statements like, "I hear that you're really upset about the wait times...." Physicians can also restate, paraphrase, or clarify, which shows that you understand and are listening.

3. Stay calm.

It's important to control reactions and avoid getting caught up in the patient's emotions. Try to determine why the patient is upset and say, "I can see you're upset about this procedure."

Also try to avoid playing the blame game if the patient says, "It's all your fault I am sick!" Instead, try saying something like, "I can tell you're really angry. Tell me where that's coming from."

"It's better to keep it positive so patients will stay on your side," says Howe.

4. Validate the patient's emotions.

Although patients aren't always right, it's important to validate how they feel and make them feel safe. Physicians can say, "I really want to hear you and understand what's going on, and I want to make it better," says Howe. That will help lower patients' defenses and make them more receptive to a message like, "Let's work on those next steps."

But be mindful of tone and body language and make sure it matches what you are saying, says Howe.

5. Ask the patient questions.

This can start with a simple request, such as, "Can I ask you a few questions so we can find a solution?"

Avoid being blunt or harsh with "softening" questions, such as, "If I may ask, could you please tell me...." or, "If you don't mind me asking...." or, "I was wondering...."

Use different types of questions to discover more information, and avoid yes/no answers. "You want them to really start talking and open up with information," she says.

Howe described two types of questions that can elicit more information:

  • Dummy-up: Pretend that you don't know anything and say things like, "Tell me more about what happened" or, "I think I understand...."

  • Reverse question: Answer questions with a soft reverse question, such as, "Good question" or "I'm glad you asked that."

6. Apologize only when you've come up short.

Apologies are not always about assigning blame. They're also about expressing regret that someone is upset.

For example: "I'm sorry you were inconvenienced by this" or, "I really regret the time you've had to spend on this issue. I know you're busy."

7. Be politely powerful with patients in error.

Sometimes, patients get it wrong. They may be mistaken about a bill or misrepresent facts or just want to get their way. Start by getting to the bottom of the patient's assertions.

If something sounds wrong, dig deeper with questions. Use a gentle tone to educate, such as, "I'm glad you pointed that out to me. I can see where it would be confusing," says Howe. A staff member can also review their statement with them.

8. Deliver a solution.

Remember that the goal with patients is to build long-term relationships. "Through your tone and words, show they're valued patients and you're there for them." She recommends that problems be solved happily, quickly, and generously. For example, if a typo is made on a statement, the billing person should say, "I will go and take care of it right now."

9. Be politely assertive with unreasonable patients.

Some patients will never be happy no matter what is said and done. With these patients, use more direct questions to find out what the ideal situation is and what will make them happy. Ask questions such as, "What would you like to see here that would make you happy?" However, if they are cursing and really angry, a better approach may be to shut down the conversation until they are calmer.

10. Thank the patient and check back.

No matter what the problem is, it's important to follow up. One approach is to document that a patient was upset and include the proposed solution in the patient's medical record notes.

When a patient leaves that day, the scheduler can follow up with a call or send a letter if the patient's unavailable, asking if they were okay with the solution and how it was handled. "Then you can thank the patient for bringing the problem to your attention and say that you want to keep improving," says Howe.

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