Surgeons must learn the ‘art’ of addressing aggressive, abusive patients
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KOLOA, Hawaii — Interpersonal relationship skills can be an overlooked quality that oculoplastic surgeons would do well to develop, Eli L. Chang, MD, FACS, told fellow panelists at Hawaiian Eye 2020.
In a panel of case presentations, both Chang and George B. Bartley, MD, recalled their most difficult cases as being not surgical challenges but rather emotional interactions with an abusive patient or family member.
In Chang’s case, a patient with congenital arterial malformation who had undergone various treatments over many years reacted in anger when he was told further treatment would likely do no good.
“As a surgeon, I don’t know that counseling is exactly our forte, but what do you do when you have a patient who explodes?” Chang asked.
There’s an “art” to counseling patients, according to moderator Wendy W. Lee, MD.
“There is a lot of counseling involved in what we do,” she said, adding that when she tells a patient “no,” she follows with a discussion encouraging the patient’s positive mental attitude. “It’s a really important skill to have.”
In Bartley’s case, a patient’s family member became verbally abusive to staff when a ptosis repair was canceled for her elderly mother, for whom Bartley could not obtain informed consent.
“The daughter was … incredibly abusive to our allied health staff, and that’s a line you simply can’t cross,” Bartley said. “And so, I canceled the case and I terminated the relationship with the patient, unfortunately. … This was a very disappointing outcome. It was only the second time in my 35 years of practice where I’ve had to ‘fire’ a patient.”
In a paper published in the New England Journal of Medicine, researchers found about half of surgical residents surveyed experience some sort of mistreatment, commonly at the hands of patients and their families, Bartley said.
“I was surprised to see how often it happens,” he said. – by Patricia Nale, ELS
References:
Battle of the beasts: challenging cases in functional eyelid surgery. Presented at: Hawaiian Eye 2020; Jan. 18-24, 2020; Koloa, Hawaii.
Hu YY. N Engl J Med. 2019;doi: 10.1056/NEJMsa1903759.
Disclosures: The panelists report no relevant financial disclosures.