It’s a scenario that any practicing physician will be familiar with. You get a call that a patient or family member is “very upset” or “angry” about something. I’ve written previously about this topic, and some basic communication techniques for dealing with this. Most times—the physician who is going about their busy day will be completely taken by surprise by whatever the complaint is. They will be summoned to speak to the patient or family totally out of the blue. The request, usually from a nurse, may elicit an eye-roll from the doctor, before they will diligently go and deal with the situation. It’s important that no physician or anyone else who works in healthcare views these scenarios in an overly negative light. Healthcare is an emotionally-charged field, and people are not themselves at anxious times in their lives. Dealing with these situations is very much a part of the job description, and needs to be done correctly. I’m not talking about the extreme reactions—such as somebody who is unacceptably verbally abusive or physically aggressive—but the everyday complaints that get those emotions running high. It could be a delayed or cancelled test, an expectation to be discharged from the hospital, or frustration with a lack of diagnosis.

I’ve seen the most experienced physicians handle these situations very badly, and needlessly escalate an already charged situation. The rule is one of basic de-escalation, and realizing that we are there to calm things down. Here’s the playbook:

1.Doctor gets a call about a tense situation

2.Don’t get emotional yourself or lose your composure, process the details of what’s happened, and what the complaint is

3.Before entering the room, gather as many details about the case as possible so that you are able to answer any questions that may be thrown your way

4.Take a few deep breaths, make sure you are calm yourself, and remember your goal is to de-escalate this situation. When you walk into the room, the body language of those in there, may be very obvious. They may have visibly angry faces (red and scowling) or standing tall with a stiff posture—arms folded. Use your own judgment about what your own disposition, energy level, and facial expression should convey, and whether or not to shake hands immediately

5.Start off with a statement like: “Sorry for the misunderstanding” or “Sorry for what happened”. Then comes a simple: “Tell me what happened”

6.Get everybody—including yourself—sitting down, if practically possible. I could talk for a very long time on the psychology of sitting down versus standing up, but suffice to say for now—just do it!

7.Let the patient or family speak for a few minutes and get everything off their chest. Do not interrupt, defend or worst off all—argue back! Just listen, listen, listen. And absorb, absorb, absorb. You are not going to act defensively, argue your point, or dismiss any concerns—no matter what you believe

8.After they are done talking, calmly go over things again, and make sure you are clear on the complaints. Present a clear and concise plan to rectify things. Then pivot to the future, and work out a plan going forward. Always ask if there’s anything else you can do to make things better

9.When you leave the room, leave on a positive note and shake hands

10.Close the loop. You are not just going to “disappear” after the issue is addressed in that moment. Check in later the same day if you can, or if not—the next day

I have lost count of the number of times I’ve seen physicians go horribly wrong in how they deal with these scenarios. Before you know it, things have spiraled out of all control! The main thing to remember is point number 7 above. The physicians’ role as the de-escalating influence: Non-judgmental, non-argumentative, and there only to be the mature calming energy.

It’s my observation after years of practice that only a handful of people out there are really unreasonable. Well over 90 percent of the time, patient and family concerns and complaints have a solid basis, and we must deal with them in a professional manner. By utilizing the right communication techniques, almost any angry or tense situation can be quickly calmed down. Get it wrong however, and things can go horribly wrong very quickly. Ultimately, these suggestions would work in any customer service situation when you need to diffuse a situation—whether you are a doctor, a restauranteur, or a hotel manager (and even in your personal life too!). People are people, and the same emotions always apply, as do the skills for dealing with them. Never under any circumstances respond to anger with anger, which only serves to pour fuel on the fire. Don’t just react, but choose how you respond. Or as the famous neurologist, psychiatrist, and Holocaust survivor, Dr Viktor Frankl said: “Between stimulus and response there is a space. In that space is our power to choose our response”. Deliberately go into the “zone” of being the active listener and problem solver, always showing the empathy and compassion of the good doctor.

…Or as the British like to say: Keep Calm and Carry On!

Suneel Dhand is a physician, author and speaker. He is Co-Founder at DocsDox and Founder at DocSpeak. His latest keynote presentation is: “Using amazing everyday communication techniques to improve patient experience and healthcare outcomes”. Learn more about him here.

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