Bariatric Times - August 2008 - (Page 16) Consultant’s Corner Bariatric Times • August 2008 Consultant’s Corner All from Stevens & Lee, Lawyers and Consultants Understanding Bariatric Risk—A Legal, Clinical, and Customer Service Focus by James W. Saxton, JD; Maggie M. Finkelstein, JD; and Susan Gallagher Camden, RN, MSN, PhD Most of our patients and staff members get along fine. However, occasionally a patient or family member will become unreasonably upset, affecting staff members and even other patients. Our office manager is responsible for handling angry patients, but last week he was out of the office when a patient’s wife became very upset and the receptionist didn’t really know what to do. The situation really got out of hand. Any ideas? Experts: Angry patients and family members pose one of the most unsettling challenges for an office practice. However, it is important to recognize that however unsettling, anger is part of being human. We see it expressed everywhere—sometimes for good reason, sometimes not. Most experts explain that anger is simply a feeling; it is not necessarily bad or good any more than joy, hurt, or fear is considered bad or good. It is not feeling anger that causes problems; it is what the angry individual chooses to do when feeling angry that is either productive or unproductive. For this reason, anger can be a very difficult emotion. Both our own anger and other people’s anger can create stress. It is important to recognize that anger is a secondary emotion, meaning it occurs after some other feeling occurs. This is why anger is so stressful in healthcare. Patients and even healthcare providers might feel angry after feeling misunderstood, afraid, or hurt. Many people feel anger in the face of criticism, but first the person probably felt hurt. This is important to understand—anger functions in response to a threat and is often used to block off physical or emotional pain. On the other hand, while anger allows a person to vent frustration, it seems to create problems in two ways. One way is when angry expression is used to escape the core feelings the anger is attempting to mask; the other way is when anger is suppressed or repressed or expressed inappropriately. Repressing anger tends to distort one’s ability to understand the core feelings the anger is masking. Patients are best served when they learn to recognize hurt, fear, frustration, or anxiety and what causes these feelings, so they can continue their journey toward success. The second problem that angry expression leads to is fear and defensiveness of others. Anger expressed in the form of rage, passiveaggressive behavior, or defensiveness creates problems not only because this expression of anger causes damage to others, but because the real issues are not addressed. It is very difficult to stay in a problem-solving mode when someone is yelling or raging. It is also very difficult to solve problems when people behave in passive-aggressive ways. The most typical, and human, reaction by the healthcare professional who is confronted by the angry patient or family is to either get angry back or to physically or psychologically withdraw; neither are helpful coping strategies. Most practices, like yours, have assigned an individual staff member to address issues pertaining to the angry patient. You recognize the problems inherent with this process by virtue of the question asked. Patients who express this feeling of anger in an inappropriate manner seldom schedule this at the time your staff member is available to intervene. Anger is a difficult feeling for both patients and staff members because it does not feel good and is not acceptable in our culture. Staff members are often unclear how to respond in the face of an angry individual. The good news is that you can put into place strategies that can help. A policy in writing to handle the needs of the angry patient is part of a sound loss-control program. In developing a policy, consider ways to engage the patient for purposes of better communication (Table 1). The BATHE model is one such model designed to help clinicians understand and manage needs of the angry patient and responses of staff members (Table 2). As with any difficult patient situation, communication techniques are especially important so that the patient, staff members, and surgeons do not become further frustrated. The BATHE Model is designed to create an empathetic environment. Both of these models should be considered in creating a policy for handling an angry patient. A policy does not only help staff understand the expectations and process, but also assists in staff training and education efforts as well. A policy should include not only understanding the process and reasons for management of the angry patient, but also role playing. CASE STUDY: HANDLING A DIFFICULT PATIENT Let’s use an example of a patient who always seems to come into the office complaining about something. Annette has complained about the weather, traffic, and parking, or how long she has to wait. When Annette enters the office, staff members feel and express their frustration before an interaction even occurs: “Oh, not her. I didn’t see her on the schedule for today!” What is the stressor? Annette. What is the painful core feeling? Anxiety. Staff members feel anxious, probably because they believe they ought to be able to make Annette happy. It is interesting that we call people like Annette difficult when the real problem is that we do not know what to do with them. Think about this: They are very consistent in their behavior. They always come in and complain. So, the real problem is that we often think we have to fix whatever they think is wrong. A key in managing our own anger and that of others is being able to stay separate from them. What is essential is the ability to see that another person’s complaints, anger, or frustration may have little to do with the office or staff members. The patient may simply be mad at life. From a risk management perspective, a written policy is helpful to guide all staff members on all levels in understanding the process of handling an angry patient and their role in promoting customer service excellence. The written policy ought to describe avenues the staff member might take in addressing this challenge. The goal of the policy is to work toward consistency in customer service excellence and satisfaction while maintaining respect for patients and staff members. For example, when patients become angry and express their anger inappropriately at staff members, staff members who work in a professional environment lose the right to react. Keep in mind, professionals do not lose the right to self respect— just the right to respond in a like way to an inappropriate patient. For example, consider the following scenario: Annette: (Patient arrives 30 minutes late for her appointment and angrily registers at front desk) “This isn’t going to take long, is it?” Receptionist: “There is one patient ahead of you, so it’s going to be about 10 minutes before you will see Dr. Hughes.” Annette: (In a very angry and quite loud tone) “Ten minutes! You’ve got to be kidding. I had a two o’clock doctor appointment and he didn’t even see me until 3:15. That is why I am late. You people must think we have nothing better to do than to wait for you! What is the matter with you?” Receptionist: “It sounds like you’ve had a very frustrating day. It’s aggravating when you’re busy and people don’t keep their appointed times. I do have one patient in front of you; it won’t be longer than ten minutes. Annette, Dr. Hughes wants to have enough time to review your postoperative lab values with you today.” Annette: “This is ridiculous! What the *&!# is wrong with you people? You and the doctor are all alike!” Receptionist: (Calmly) “Annette, it sounds like you’re frustrated, but I don’t want to be sworn at or yelled at. Let me have you speak with our office manager while I set up for your visit so you aren’t delayed any more.” Annette: “No, no, I’m fine. You’re right, I am just so frustrated, and I have horrible headaches today.” Receptionist: “Well then, you are in the right place and we are glad you are here…can I get you something while you wait?” DISCUSSION This receptionist does not allow the patient’s bad day to ruin hers or In developing a policy, consider ways to engage the patient FOR PURPOSES OF BETTER COMMUNICATION.
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