Difficult patient interactions are a common experience for medical providers. Several factors may contribute to these encounters, including strong emotions from patients, somatization, unrealistic expectations, and mental health issues. Environmental or situational challenges such as busy schedules, the presence of multiple people in the exam room, language barriers, literacy issues, and provider-related concerns like fatigue or burnout can also play a role.
Recognizing when an encounter is becoming difficult is considered the first step in managing these situations. This realization might occur before meeting with a patient or during the visit itself. Providers are encouraged to reflect on why certain patients or encounters evoke strong emotions.
According to guidance for handling such scenarios: “Emotions are never wrong but can be detrimental to a provider-patient relationship depending upon how they are identified and managed. While a patient’s anger may be a frequently cited emotion in a difficult encounter, it is important to remember that anger is often the result of an underlying primary emotion such as fear or sadness.”
Some suggested techniques include acknowledging both the patient’s and provider’s emotions directly during the interaction. For example: “Acknowledge emotions: Acknowledge the patient’s and your emotions. Don’t be afraid to call out an emotion, such as, ‘I can see you are angry.’ If the patient corrects you and says, ‘No, I am not angry just frustrated,’ take that as a positive as you have already begun to deescalate the situation. Let the patient know you are having challenges as well, ‘I am having difficulty as I really want to help you, and I am frustrated we haven’t found a better solution for you.'”
Reflective listening is another recommended approach: “Reflective and active listening: Summarize what you are hearing from the patient, ‘I hear you saying you are frustrated as your pain has not improved and it is limiting you at your job.’ Brief summary statements are an effective way of expressing empathy. Pay attention to your body language as nonverbal communication contributes more to interaction than the words you say—stay calm, lean in, and pay attention.”
Providers may also find it helpful to apologize when appropriate: “It’s okay to say I am sorry: While sorry statements are not necessarily a form of empathy, it may be appropriate to say things as, ‘I am sorry I kept you waiting so long,’ and then follow it with an empathic statement, ‘I know you must be very frustrated.'”
The guidance emphasizes viewing care as a partnership between provider and patient: “This is a partnership: You may discover that in your exploration that the patient has unrealistic expectations (i.e., ‘I want to be pain free.’) and you can work toward an agreement to work together on a reasonable goal. ‘I want to be transparent—I may not be able to relieve all of your pain, but we can work together to improve your symptoms such that you can return to work and enjoy your life outside of work.'”
Relationship-building takes time according to this advice: “Recognize it will take time: Building a relationship and/or behavior modification takes time. Set reasonable goals on what may be accomplished in one visit.”
Finally, communication skills among providers require ongoing practice; participating in workshops or being videotaped during interactions can help improve these abilities.
