How To Deal With Angry Patients: A Rad Tech’s Guide
How To Deal With Angry Patients and How To Handle Them: A Rad Tech’s Guide
Guidelines for how to handle angry or upset patients effectively, including techniques for how manage and de-escalate tense situations.
Workers in healthcare settings face significant risks of workplace violence [1]. According to the US Occupational Safety and Health Administration (OSHA), healthcare workers (HCWs) are four times more likely to be victimized than workers in private industry [2]. In fact, dealing with angry or frustrated patients is considered an occupational hazard of working in healthcare and as many as 15% of all patient encounters involve angry patients [6] [7]. Due to the nature of their work, radiologic technologists interact with patients of varying physical, mental, and emotional states, and it’s not uncommon for them to come across frustrated or angry patients in radiology department [8]. Knowing how to handle an angry patients is therefore a valuable skill for rad techs. In this article, we’ll address how to deal with and handle angry patients, including everything from identifying the common underlying causes of patient anger, how to recognize early signs that a patient may be or become angry, and how to handle the situation when a patient becomes upset in order to better ensure the safety and wellbeing of the patient, caregivers, visitors, and yourself.
- Patient Anger in Healthcare Settings
- What are the root causes of patient anger?
- Recognizing Signs of Patient Anger
- Patient Anger Continuum: 6 Phases
- How to Deal with Angry Patients in Healthcare Settings
- Conclusion
- References
The gist: In healthcare settings, up to 15% of all patients encounters involve angry patients.
Patient Anger in Healthcare Settings
How To Deal With Angry Patients
What is anger?
Anger can broadly be described as a person’s emotional response to some perceived barrier that interferes with reaching a reward [9]. Anger can be suppressed, such as when directed inward toward the self, or it can be directed at others in the form of confrontations or aggressive behavior [4]. Anger exists on continuum that ranges from mild frustration or irritation to hostility, or even rage. And when it is uncontrolled, anger can have a negative impact on social, occupational, and psychological functioning and well-being [9].
Anger is one of the strongest predictors of violence and aggression in healthcare settings [4]. In fact, feelings of anger that cannot be expressed by appropriate means and that have not been addressed effectively, often result in verbal or physical violence [5]. This, of course, is a major reason that you must make a conscious effort to learn how to deal with angry patients safely and effectively.
The gist: Anger is an emotional response to a perceived barrier toward a goal or reward, and it can manifest in ways ranging from irritation to violence.
What are the root causes of patient anger?
How To Deal With Angry Patients
Medical environments can create high levels of stress for patients, and patient fear, vulnerability, and illnesses often increase tensions even more [2]. It is important to remember that a combination of the patient’s situation, condition, or psychosocial environment can trigger feelings of anger [3]. And before you can learn how to effectively deal with angry patients, you must have a solid understanding of the major causes of their anger.
- Pain: Medical illness is often accompanied by pain. Anger is a common emotion in patients with pain, especially chronic pain. And to compound the problem, it is thought strong feelings of anger may, in fact, further aggravate patient pain, resulting in a negative feedback loop of pain and anger.
- Fear and worry: Being medically ill and hospitalized can be an intensely destabilizing experience for a patient. An unknown prognosis, the occurrence of complications, or the impact of the illness on a patient independence can make a patient fearful about their future. This worry can manifest as anger, and since patients cannot take their anger out on their illness, it may be displaced onto and directed at people around them, especially direct caregivers.
- Feeling unheard or uninvolved: Anger can arise out because some patients may feel unheard. They do not feel that they are involved in their care or may feel that they do not have enough information about their condition. Some patients may feel that their concerns have not been addressed or have even been dismissed by healthcare personnel. All these feelings may be expressed by anger.
- An unidentified medical condition or psychiatric disorder: Some patients may have underlying psychiatric or medical condition, such as the withdrawal from an addictive substance or the presence of major depression or delirium, which may cause them to become very angry or irritable toward their caregivers [10].
The gist: In healthcare settings, factors related to both the patient and the healthcare provider can contribute to patient anger. The 4 major root causes are: pain, fear and worry, feeling unheard or uninvolved, and an unidentified medical condition or psychiatric disorder.
Recognizing Signs of Patient Anger
How To Deal With Angry Patients
Patients can express anger in many different ways, not all of them obvious. It is essential for a caregiver to spot the signs of anger early before the patient reaches a climax and loses control [6]. Learning the signs of anger will allow you to use them as cues to switch into a more mindful and self-aware mode of interaction that may help diffuse a situation before it erupts [9].
- Physical signs of anger may include facial flushing, glowering eyes, knitted brows, pursed lips, tightened jaw, tense posture, clenched fists, fidgeting, or adopting an aggressive stance [6] [4].
- Behavioral manifestations may include yelling, swearing, becoming quiet, or simply changing from baseline behavior.
And some patients may not provide overt signs of anger, but might passively demonstrate their anger through their actions, such as refusing to comply with medical treatment. Some may start to raise their voice; or a talkative person may suddenly become quiet [4].
The gist: Some early signs of anger are obvious and familiar to everyone, but some are less obvious. Some patients may become quiet, noncompliant, or passive aggressive when angry, and it is important to be aware of these signs, too.
Patient Anger Continuum: 6 Phases
- Calm and nonthreatening: A patient may be frustrated but fail to show overt signs of agitation.
- Verbally agitated: A patient may say something like, “This is ridiculous. I can’t believe I have been sitting in here for 45 minutes.”
- Verbally hostile: A patient may shift from using phrases that express discontent to using unkind phrases.
- Verbally threatening: A patient may demand an apology or threaten to sue.
- Physically threatening: A patient may assume a fighter’s stance and make a fist.
- Physically violent: A patient may attempt to injure healthcare providers.
Patients in phase 1 of this continuum are still able to think logically and respond appropriately, so it is very important for you to know how to deal with angry patients in an effective way and how to use techniques that will keep patients in this lower phase of the continuum or, if they have passed this phase already, redirect them to this calm, non-threatening stage in order better ensure your own safety, the safety of the patient, and the safety of others [9] [4].
The gist: Spotting early signs of patient anger gives you the opportunity to de-escalate a difficult situation before it gets out of control.
How to Deal with Angry Patients in Healthcare Settings
As a healthcare provider, you should always keep in mind that patient anger can escalate to violence. So, how, exactly, are you supposed to handle angry patients?
Well, your first step is to remain calm and allow the patient to express his or her concerns. This can be difficult sometimes, as the patient may be using hurtful words towards you or towards your coworkers or institution. Just remember the root causes of patient anger: the patient might be afraid, in pain, feeling dismissed, or have a psychiatric problem. It is highly unlikely that you are the cause of the patient’s anger. While you are keeping yourself calm and letting the patient voice their concerns, assess their anger stage along the continuum in order to gauge what sort of techniques you can use to best diffuse the situation[10].
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Verbal and Behavioral De-escalation Techniques
You should start by employing verbal and behavioral de-escalation techniques when dealing with a situation in a patient is openly expressing anger [4].
- Agree/Admit to the facts of the situation. This is exactly what it sounds like. If the patient has been waiting for 45 minutes, agree to that fact, admit to that fact, rather than trying to deflect it by saying something like, “We’re very busy right now. Everyone is waiting.” Instead, a simple agreement can go a long way toward making a patient feel like they are being heard.
- Acknowledge the impact of the situation on the angry person. In our example of the patient who is angry about long wait times, you might acknowledge that this sort of delay must be frustrating and has probably thrown off their whole plan for the day or is making them anxious while they want answers about their healthcare concern.
- Apologize to him or her and express regret that the situation occurred. Even if it isn’t your fault (and often it won’t be), offer an apology to the patient. This gets easier when you remember that the patient may be frightened or in pain or feeling dismissed and worried about their health and that expressing anger may be the only thing they have control over at the moment.
- Act to correct the situation and minimize the consequences [6]. Taking action is important here. If you only offer an apology and then go back about your business, the patient may feel that you have been insincere and dismissive and may become even more upset. Try to correct the problem, or at lest find out the reason for its occurrence. Make a phone call or two and keep the patient informed. If a patient can see that you are taking steps to assist them, it may relieve some tension and reduce their anger.
- Respect a patient’s personal space; keep a safe distance and avoid touching the agitated patient
- Maintain a neutral posture
- Do not stare; eye contact should convey sincerity
- Stay at the same height as the patient; do not look down on them
- Avoid sudden movements [7] [4].
Protective Measures
- Position yourself between the patient and the door, so you can exit the room if the patient becomes threatening or violent
- Press the panic button if you feel unsafe
- Do not go into the patient’s room alone
- Try to interview or treat aggressive or agitated patients in relatively open areas that still maintain privacy and confidentiality. if possible
- Legal protection: document the patient’s complaints, the responses of the physician and healthcare institution to these complaints, and the outcome of each incident to protect yourself, physicians, and your institution from frivolous lawsuits
- Label patients who have a history that suggests a tendency for anger or violence [11].
- Engineering control strategies and workplace adaptations include using physical barriers (such as enclosures or guards) or door locks to reduce employee exposure to the hazard; metal detectors; panic buttons, better or additional lighting; and more accessible exits (where appropriate)
- Administrative and work practice controls are appropriate when engineering controls are not feasible or not completely protective. These controls affect the way staff perform jobs or tasks, such as implementation of a workplace violence response policy and systems for tracking patients with history of violence and tracking workers (log in/log out procedures) [11].
The gist: When dealing with an angry patient, start by employing verbal and behavioral de-escalation techniques. In case of severely agitated patient, you should take additional protective measures immediately!
Conclusion
Sickness, pain, and wait times can lead patients to feel frustrated and angry [12]. Knowing how to deal with angry patients and how to handle a situation well and effectively to de-escalate and diffuse tension will serve you well in your career as a technologist, as angry patients are a common challenge you’ll likely deal with often in your career. Detecting signs of anger early, and following up with proper communication and effective management of the situation will help keep the focus on getting the patient healthy and ensure the safety of the healthcare personnel, patients, and visitors [13]. Talk to your institution about continuous evaluation of the root causes of patient anger and of the effectiveness of the implemented protective measures, along with training programs for healthcare personnel on how to deal with patient anger, all of which can help prevent and control workplace hazards and incidents of violence [4] [11].
An effective management of patient anger by caregivers will reduce the likelihood of violence incidents.
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References
- Physical and verbal violence against health care workers. (2018). Sentinel Event Alert, (59), 1–9. [Link]
- Occupational Safety and Health Administration (OSHA). (n.d.). Preventing workplace violence in healthcare. [Link]
- Sisawo, E. J., Ouédraogo, S., & Huang, S. L. (2017). Workplace violence against nurses in the Gambia: mixed methods design. BMC Health Services Research, 17(1), 311. [Link]
- Chipidza, F., Wallwork, R. S., Adams, T. N., & Stern, T. A. (2016). Evaluation and treatment of the angry patient. The Primary Care Companion for CNS Disorders, 18(3). [Link]
- Gautam, M. (2015). What is your leadership style? Skills for advancement. The Canadian Journal of Physician Leadership, 1(4), 10-13.
- Davies, N. (2021, October 11). De-escalating patient anger. Independent nurse for primary care and community nurses. [Link]
- Stempniak, M. (2019, September 25). 4 tips for how radiologists should respond to angry patients. Radiology business. [Link]
- Cianfrini, L., Doleys, D., & Richardson, E. (2021). Pain psychology for physicians: A practical guide for the non-psychologist managing patients with chronic pain, Oxford University Press.
- Vahabzadeh, A. (2014, April 3). 4 reasons why patients may become angry. Medpagetoday’s KevinMD. [Link]
- Occupational Safety and Health Administration (OSHA). (2016). Guidelines for preventing workplace violence for healthcare and social services. [Link]
- Heathcare Providers Service Organization (HPSO). (n.d.). Handling the angry patient. [Link]
- Clancy, C. (2018, November 20). 8 effective ways to handle angry patients and families. [Link]
- American Psychological Association. (n.d.). Anger. [Link]
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