How to Respond to Abrupt, Rude, Defensive, or Aggressive Patients as a Healthcare Provider?

I often get asked how to handle patients, staff members or even employers who are abrupt, rude, defensive or aggressive. As this fits in with my theme for July of managing personal state, I decided to write this article on effective strategies to respond to such situations while promoting a positive relationship and ensuring the best possible outcomes.

This is a guide not a recipe. 

These behaviours may arise due to various reasons, such as pain, fear, anxiety, or frustration with their condition or something else that is going on in their life. 

You won’t know the cause of their emotional outburst until you allow space for the patient or other person to ‘empty the bucket’ without interruption. A hard thing to do when you feel attacked by another person.

1. Stay Calm and Composed:

At all times it is essential to maintain professionalism and handle these situations with empathy and composure. In the clinical situation it is unlikely that you’re the primary cause of the outburst.

Encountering a patient who is abrupt, rude, defensive, or aggressive can be emotionally taxing. However, it’s crucial to remain calm and composed in these situations. Take a deep breath and remind yourself that to help them you need to appreciate their situation. Responding with anger or frustration will only escalate the situation and hinder effective communication.

2. Active Listening:

One of the most important skills in managing emotional patients is active listening. Give the patient your full attention, remove any distraction both internal and external and show genuine interest in their concerns. Allow them to express their feelings and frustrations without interruption. Once they finish ask if there is anything else. If there is, ask the same question again when they stop talking. Eventually the answer to this question will be ‘No’. Now they have ‘emptied the bucket’ and it’s time to find out what the main problem is.

Sometimes, patients may just need someone to listen to their grievances to feel understood and valued. Other times they need someone to help them sort through a number of frustrations before they can deal with any of them, let alone the main one.

3. Empathise with Their Feelings:

Put yourself in the patient’s shoes and try to understand their perspective. Empathy is a powerful tool to diffuse tension and build trust. Acknowledge their emotions and let them know that although you may not fully understand what they’re going through, you’re prepared to try, even if you may not fully agree with their behaviour.

4. Address the Issue Diplomatically:

Once the patient has expressed their emotions, address the main issue diplomatically. Allow them to express what the main issue is and ask for more information regarding this issue if you need to.

If they continue to list a number of issues, ask gently and sympathetically again, what is the main issue for them.

Avoid becoming defensive, engaging in a power struggle or using logic in the early stages of the conversation. This will only escalate the problem. Instead, use a calm and respectful tone to communicate your willingness to understand their concerns.

5. Set Boundaries:

While it’s essential to be empathetic, it is equally crucial to establish clear boundaries regarding acceptable behaviour. If after ‘emptying the bucket’ they still treat you disrespectfully, let the patient know that while you recognise their frustrations, being rude or aggressive is not acceptable. Kindly inform them that you are there to help and work together towards sorting out the problem, but you expect mutual respect during the process.

6. Reframe Negative Statements:

Some patients may express negativity or dissatisfaction with their progress or treatment. In such cases, use positive reframing to redirect the conversation. 

For example, if a patient says, “This treatment is useless; it’s not helping at all,” you can respond with, “I can see that you’re frustrated, would you be open to exploring your concerns together and find ways to make the treatment more effective or consider other treatment options?”

7. Offer Options and Involve the Patient:

Giving patients some sense of control can help reduce defensiveness or aggression. Offer them choices and involve them in decision-making regarding their treatment plan. 

Employing the power of ‘no-orientated’ questions is an effective way to hand control back to the patient. By saying ‘no’ to something that bothers them, it frees them to say ‘yes’ to an option that is more agreeable. 

You might think their alternative is not the best option, but in this conversation, defusing the situation and building collaboration is more impactful than using logic and advice to convince the patient to agree with your best option. 

This collaborative approach empowers patients and increases their commitment to ongoing management.

8. De-escalation Techniques:

In some situations, patients may become highly agitated or aggressive. It’s essential to have de-escalation techniques in your toolkit. 

Techniques such as ‘labelling’ which I have written about in a previous article is very effective. 

Using ‘It sounds like/looks like/feels like/seems like’ followed by the appropriate emotions can be help. Even if you get the label wrong, the patient will quickly correct you. Now you’re clear on the real problem and as the patient vents, they’re likely to de-escalate. 

9. Seek Supervisor or Colleague Support:

If you encounter a particularly emotional patient or find it challenging to handle their behaviour, don’t hesitate to seek support from a supervisor or a colleague. Discuss the situation and seek advice on how to best manage the patient’s needs and emotions.

Fortunately these situations don’t happen frequently but this means we don’t often have the opportunity to build up the skills to handle them. 

10. Reflect and Learn:

Each encounter with an emotional patient provides an opportunity for growth and learning. After the session, take some time to reflect on the interaction. Consider what worked well and what could be improved in your response. Continuous self-improvement and skill development can enhance your ability to handle similar situations in the future.

Remember, responding to abrupt, rude, defensive, or aggressive patients is a skill that requires practice and patience. By remaining calm, empathetic, and professional, you can turn these challenging interactions into opportunities for building lasting relationships.  

By integrating the principles discussed in these books with your clinical expertise, you can navigate emotional patient interactions with greater confidence and compassion.

References:

• “Difficult Conversations: How to Discuss What Matters Most” by Douglas Stone, Bruce Patton, and Sheila Heen. This book provides valuable insights into handling challenging conversations and emotions effectively, which can be applied to patient interactions in the healthcare setting.

• “The Empathy Effect: Seven Neuroscience-Based Keys for Transforming the Way We Live, Love, Work, and Connect Across Differences” by Helen Riess, MD. This book explores the power of empathy in building meaningful connections and resolving conflicts, offering practical strategies for fostering empathy in challenging situations.

• “Never Split The Difference: Negotiating as if your life depended on it” by Chris Voss. This book has a number of examples of negotiators dealing with extremely emotional people. They are terrorists and have nothing to lose. I can highly recommend this book as it is both entertaining and informative. It covers the use of labels extremely well.

What I offer you and your staff?

Skills practice and reflection will be the cornerstone of my training. I am available for both in person and limited Zoom PD for your group.

If you have a staff member who is struggles keeping new patients or confidently presenting treatment plans, you might be interested in one-on-one coaching for him/her. I take on a limited number of clients each year.

If you would like to engage me to work with your staff or coach a member of your team, click here so that you can schedule a time to discuss your specific training needs.

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