How to Communicate Effectively With Patients When Tensions Run High

Thomas R. Collins

April 30, 2022

CHICAGO — The COVID pandemic left hospitalist Ngozi Nwankwo, MD, with the most difficult patient interactions she had ever experienced.

"At my hospital, it was such a big thing to make sure that families are called," said Nwankwo, in an interview following a session on compassionate communication at the annual meeting of the American College of Physicians. "So you have 19 patients, and you have to call almost every family to update them. And then you call, and they say, 'Call this person as well.' You feel like you're at your wit's end a lot of times."

Sometimes, she has had to dig deep to find the empathy for patients that she knows her patients deserve.

"You really want to care by thinking about where is this patient coming from? What's going on in their lives? And not just label them a difficult patient," she said.

Become Curious

Auguste Fortin, MD, MPH, offered advice for handling patient interactions under these kinds of circumstances, while serving as a moderator during the session.

"When the going gets tough, turn to wonder." Become curious about why a patient might be feeling the way they are, he said.

Fortin, professor of internal medicine at Yale University, New Haven, Conn., said using the ADOBE acronym, has helped him more effectively communicate with his patients. This tool cues him to keep the following in mind: acknowledge, discover, opportunity, boundary setting, and extend.

He went on to explain to the audience why thinking about these terms is useful when interacting with patients.

First, acknowledge the feelings of the patient. Noting that a patient is angry, perhaps counterintuitively, helps, he said. In fact, not acknowledging the anger "throws gasoline on the fire."

Then, discover the cause of their emotion. Saying 'tell me more' and 'help me understand' can be powerful tools, he noted.

Next, take this as an opportunity for empathy — especially important to remember when you're being verbally attacked.

Boundary setting is important, because it lets the patient know that the conversation won't continue unless they show the same respect the physician is showing, he said.

Finally, physicians can extend the system of support by asking others — such as colleagues or security — for help.

Use the NURS Guide to Show Empathy

Fortin said he uses the "NURS" guide or calling to mind "name, express, respect, and support" to show empathy:

This involves naming a patient's emotion; expressing understanding, with phrases like "I can see how you could be …" showing respect, acknowledging a patient is going through a lot; and offering support, by saying something like, "Let's see what we can do together to get to the bottom of this," he explained.

"My lived experience in using [these] in this order is that by the end of it, the patient cannot stay mad at me," Fortin said.

"It's really quite remarkable," he added.

Steps for Nonviolent Communication

Rebecca Andrews, MD, MS, another moderator for the session, offered these steps for "nonviolent communication":

  • Observing the situation without blame or judgment.

  • Telling the person how this situation makes you feel.

  • Connecting with a need of the other person.

  • Making a request that is specific and based on action, rather than a request not to do something, such as "Would you be willing to … ?"

Andrews, who is professor of medicine at the University of Connecticut, Farmington, said this approach has worked well for her, both in interactions with patients and in her personal life.

"It is evidence based that compassion actually makes care better," she noted.

Varun Jain, MD, a member of the audience, expressed gratitude to the session's speakers for teaching him something that he had not learned in medical school or residency.

"Every week you will have one or two people who will be labeled as 'difficult,' " and it was nice to have some proven advice on how to handle these tough interactions, said the hospitalist at St. Francis Hospital in Hartford, Conn.

"We never got any actual training on this, and we were expected to know this because we are just physicians, and physicians are expected to be compassionate," Jain said. "No one taught us how to have compassion."

Fortin and Andrews disclosed no relevant financial relationships.

This article originally appeared on, part of the Medscape Professional Network.


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