Unsurprisingly, people are more stressed than ever before. According to a recent poll by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, nearly half of 2,500 adults surveyed admitted to a major stressful event within the last year. More than a quarter tied their specific stressor to a health-related problem.
And when that outside stress becomes too much for patients (see sidebar below), physicians may witness more angry or violent behavior in the exam room.
Acknowledge the anger
Emergency rooms are notorious for running high on emotional energy, simply due to the nature of the operation. So it can be difficult to pinpoint what is triggering a patient's outbursts.
Aaron Braun, medical director of PhysiciansER Mission Bend, a freestanding emergency room located in the Houston area, tries to find the path of least resistance. "If the patient is angry, is there some quick fix? If the answer is simple," said Braun, "I would capitulate and get them what they would like within reasonable bounds."
That may mean providing a snack or meal to a hungry patient, or if the anger is stemming from a personality conflict with staff, reassigning nurses or caretakers as needed. Regardless, the focus should be on listening and acknowledging the patient's anger, even if you can't solve the immediate problem at hand.
"Frequently, there are no simple solutions, especially if the patient is psychotic," said Braun. "And the best way to [approach] them is to talk to them in a calm and gentle manner."
As odd as it may sound, Braun relies on food to help these situations. "I always try to get the angry patient to eat something, because it gets their mind off of what is bothering them and a full stomach tends to make for a sleepy (more docile) patient."
Marc Leavey, board-certified in internal medicine and a primary-care specialist at Maryland-based Lutherville Personal Physicians, says he's seen finances become a catalyst for this type of erratic behavior too.
Is Your Patient Prone to Greater Stress?
NPR's recent study shed light on specific groups who were more likely to experience periods of great stress. Note that personal health concerns ranked among the top three groups.
• Poor health condition: 60 percent
• Disabled: 45 percent
• Chronic illness: 36 percent
• Income less than $20,000: 36 percent
• Experiences dangerous work situations: 36 percent
• Single parent: 35 percent
• Parent of a teen: 35 percent
Given the drastic changes to healthcare recently, and the misinformation that has inevitably followed, patients are rightfully concerned about being able to afford ongoing treatments. "It doesn't seem to matter if you say to the patient, 'Don't worry about [the cost] or we will deal with it [later],' they begin getting a little bit testy," said Leavey.
Remembering that these patients are most likely scared to lose their coverage or medical access can help lead physicians to a solution. "Being creative and trying to come up with a solution that meets the patient's needs while still maintaining good medical care [is ideal]," said Leavey.
And ensuring patients know about options like alternative treatments and medications can go a long way in negating their anger, especially when their concerns are based on personal finances. If a patient is most upset because they can't afford the medicine as prescribed, simply offering a generic medication — at a fraction of the cost — can resolve the entire dilemma.
Confrontation may seem inevitable in these instances, but ideally, it should be avoided at all costs.
"If you do confront [the patient], all you are going to do is make them [more] angry," said Leavey. He recalls a patient who jumped over the front check-in desk during a fit of rage. Knowing he wasn't angry at the front-desk employee, but was instead, angry in general, helped staff understand how to approach the patient.
"It sounds trite, but you have to understand where they're coming from," said Leavey. "You have to be aware of your voice and body language and avoid doing things that are obviously antagonistic."
Although it goes against human instinct, physicians will have greater success at diffusing a scenario if they remain calm and monitor their language, while avoiding raised voices or body language like crossed arms.
Don't forget to document
As in every other patient-physician exchange, documentation is key. Physicians will want to include the details of angry and violent outbursts in the patient's chart. This not only serves to forewarn other healthcare professionals who encounter the patient, but also may identify an ongoing decrease in mental health status that warrants further intervention.
Ideally, physicians would be able to diffuse every angry patient, while also determining the core of their angst. But Braun reminds us that's just not feasible. "Negotiation is an art that is learned simply by experience. Some are better at it than others," he said. "The bottom line is that the safety of the staff, other patients, and the patient must be of first priority and not every situation will allow a physician the luxury of being able to tease out the root of the patient's abnormal behavior."
Steph Weber is a freelance writer hailing from the Midwest. She writes about healthcare, finance, and small business, but finds her passion for the medical field growing in sync with the ever-changing healthcare laws.