Acknowledge anger, sadness: how to deal with difficult patient interactions.(Practice Trends)

AMELIA ISLAND, FLA. -- Do not move forward with treatment before resolving issues of anger and trust in your relationship with a patient, Dr. Thomas L. Campbell advised at a meeting sponsored by the Society of Teachers of Family Medicine.

Patient dissatisfaction with office procedures or staff, disagreement over treatment strategies, communication problems, and personality conflicts are among the many situations that can make interactions between a physician and a patient difficult.

"When disagreements arise ... do not assume that the subject of the disagreement is the primary problem, rather than a sign of a larger problem. And do not proceed with the idea that you can and will change the patient or family's mind," he said.

Patients and their families want to feel empowered, not patronized, and they want to know that you are listening to what they're telling you, said Dr. Campbell, who, along with University of Rochester (N.Y.) colleagues Susan H. Mc-Daniel, Ph.D., and Dr. Alan Lorenz, and Jeri Hepworth, Ph.D., of the University of Connecticut, Farmington, wrote a book on addressing such issues, "Family-Oriented Primary Care: A Manual For Medical Providers--2nd Edition" (New York: Springer-Verlag, May 2004).

The first step is to recognize difficult interactions (or the potential for them) when they arise and then address the issues immediately, before simmering anger has a chance to boil. "This means acknowledging the problem, asking about it, and listening to what the patient has to say. It's hard to get comfortable hearing people get angry, but it's an important skill to learn." Dr. McDaniel said.

"If a patient is feeling angry and tense because ... she had to wait too long in the waiting room, don't move right into the exam without addressing the issue, and don't respond defensively. Apologize for ...