As a hospitalist physician, I am faced with diagnosing and managing several ailments affecting adults. While there are “bread and butter” cases (i.e. urinary tract infections, cellulitis, decompensated heart failure), every patient is different and treatment plans and management vary by case. Sometimes, what we deem as the simplest of issues can become complex — requiring a deeper dive into a case as well as the assistance of specialists. During such situations, communication with the patient is key: explaining to them what is going on and answering any questions or concerns they may have.
But what happens when you have done all you can within your medical expertise, the patient says they are not getting better, and you are not helping them? What happens when the patient’s frustration turns to inconsolable anger? And what happens when the patient calls into question your ability to provide quality care as a physician?
These are the questions that were posed to me after a negative patient care experience a few weeks ago. The patient presented with generalized abdominal pain without a specific cause; imaging did not reveal an anatomical source; blood work was normal; and no pain medication or GI cocktail eased his pain. Endoscopy, stool studies, and H pylori testing all proved inconclusive. Evaluation of the patient’s history, recent travel, diet, and surgical history could also not pinpoint a cause.
As the workup continued without any substantial findings, the patient and family grew understandably more frustrated. I made every effort to keep the lines of communication open by seeing him earlier in the day to fully review his case, answering questions, and making sure the GI specialist was kept in the loop.
A few days into the patient’s stay, I received a call from administration stating he had filed a complaint against the medical team and hospital. He was also requesting a transfer to another facility. He felt he was not being treated appropriately and that the level of care he was receiving was not to the standard he expected from the facility.
Although I was initially surprised at this request, I respected it and went back to his room that day to discuss his request. Upon entering I was met with an extremely angry person and family, all of whom had something to say regarding his admission. I respectfully listened, demonstrating empathy and acknowledging his feelings — communication techniques I knew were beneficial in dealing with any upset patient. I also did not become defensive when they belittled employees and staff, however, I did request that they not verbally disrespect anyone during their outburst. Despite my best efforts to diffuse the situation, the patient still wanted to leave, so I helped facilitate the transfer once he found an attending physician to accept him onto his service.
In all honesty, I initially took the patients response and eventual transfer personally, to say the least. I had scored through the notes, looking for anything I might have missed and for what could have been done differently with the case. I had also reevaluated my communication and response to the patient to see if there was any way I could have prevented his anger. On review, I feel that myself and the rest of the hospital staff provided optimal care and the patient had been managed appropriately and to the best of our ability. While we could not find the root cause of his abdominal pain or improve the pain to a standard he was satisfied with, I do feel all methods of treatment were trialed during this particular case. Knowing this, I had fulfilled all my responsibilities in regard to charting and documenting and moved on from the case.
Despite doing everything possible, there may be times where a patient is still upset or an issue cannot be solved. It is important to recognize that a patient’s rage is not a reflection of who you are as a physician or your ability to provide quality care. In my case, it was about quality inpatient care. Making a conscious effort to not internalize negativity from a non-pleasant encounter is imperative to your own psyche and self-esteem. You cannot appease everyone. Dealing with angry patients can prove challenging, but we must always endeavor to communicate fully and do our job well.
How have you dealt with difficult or angry patients?
Akua Ampadu, MD is a hospitalist physician who is passionate about quality inpatient and outpatient adult care. As a survivor of work- and life-related burnout, she aims to provide tools necessary to live a life focused on self-care and self-advocacy. She also recognizes the importance of reading to one’s health and in 2016 launched the Healing Words Foundation, a literacy-based charity focused on providing books to pediatric wards and outpatient clinics. She is active on social media. She is a 2018–2019 Doximity Author.