BLOG: How to talk to unhappy patients
Nothing brings more anxiety to a clinician than a patient who is unhappy with our care. And the more advanced our treatments become, the higher the patient expectations.
I’ve had many fine mentors and colleagues who taught fantastic lessons in how to manage these tense moments. Applying them properly can make all the difference in saving a patient relationship. Here are my tips for communicating with unhappy patients with a reference to the source where I learned each lesson.
1. Run toward, not away, from problem patients. Julian Nussbaum taught me our human inclination is to run away from unhappy patients, but we physicians hold an obligation not to give up. Making the extra call and taking the extra time can make all the difference in salvaging a relationship, and our patients deserve the extra effort.
2. Start on the right foot. Eric Donnenfeld taught me that clinic staff must be attuned to unhappy patients, documenting carefully the source of their complaints and collecting office diagnostic tests in advance of the exam to get to the source of the problem. Armed with this information, the doctor can walk into the room, warmly greet the patient and be the first to mention that the patient is not happy. A phrase like, “I feel badly that you’re not doing as well as you need to be,” is very powerful. This is not admitting fault, but it clearly states empathy. A patient’s natural reaction is not to want to make you feel badly, so this approach disarms anger and engenders a cooperative attitude toward next steps.
3. Use physical cues. Kerry Solomon taught me to position my stool lower than the patient. This submissive posture allows the patient to feel more in control and better prepared to collaborate. Uday Devgan taught me that it’s useful to move the doctor’s stool to sit next to the patient, facing the same direction, when reviewing a test result, whether it’s printed or displayed on a screen. Facing the same way physically states that you’re both on the same team.
4. Don’t argue about the past. Focus on the future. In general, it’s best not to argue about what you told the patient in the past because it invites an argument about the informed consent. However, if you’re confident you’ve warned the patient in a previous conversation, it’s generally safe to say, “You may not remember this because we talked about a lot of things that day, but I tell every patient with your condition that ... .” This gives the patient an excuse not to remember, and it states non-threateningly that you are experienced in managing their situation.
5. Use the right words. Using different words, repeat a patient’s sentiments. This expresses attentiveness and engenders agreement. Bradley Straatsma taught me it’s good to refer to the patient’s body as having a complication rather than the patient himself/herself. “Your eye had a bad reaction to the surgery.” This places the blame not on the patient or the doctor but on the eye — a third party — whom the two of you can work together to help. It’s a subtle but effective way to shift the conversation in the positive direction.
6. Give two choices. John Potter taught me that when recommending next steps to a patient, give him or her two choices with an explanation of why you prefer one. Giving two choices shows that you’ve given their situation extra thought and are open to considering alternatives. It also gives the patient ownership of the chosen treatment.
Most medical complications are impossible to avoid and not the fault of either the patient or the doctor, but a breakdown in communication and trust is often (not always) avoidable by using strategic communication tactics. All of our patients deserve our best efforts, but our difficult ones deserve extra love and compassion that can be conveyed through these simple approaches.
Collapse