Managing an Angry Patient


The MRCGP course organisers have written some quick reference tools to help you pass your MRCGP CSA exam and aid you in your consultation skills. We recommend using and adapting them into your daily consultations to improve your communication skills. All the articles and headings below are covered on the MRCGP course in detail and role-played in the group



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Clarify the patient’s expectation
Offer an explanation if appropriate
Clarify the patient’s expectation
Preventing the complaint from happening again
Offer to escalate to complaints procedure



  • General principles with dealing with angry patients
    • Allow the patient to talk as much as possible. 
    • Listening - Show interest to what the patient says. Allow the patient to speak and vent their frustrations. Jump to the crux of the problem as quickly as possible.
    • Apologise to the patient for their experience as early as possible where appropriate. You may have to do this more than once.
    • Rapport - Establish rapport and try and use appropriate eye contact (do not stare). Maintain body language and open posture throughout.
    • Manner - Remain calm using appropriate tone and pace of voice (do not mirror the patient’s anger).
    • Behaviour - Avoid dismissing their concerns or complaints whilst also avoiding offering inappropriate reassurance.
    • Empathy – Empathise with the patient’s plight and offer your assistance.
  • Avoid 
    • Defensive - Avoid acting defensively attempting to deny responsibility. 
    • Blaming - Avoid shifting responsibility to colleagues or towards your patients; 
      • My colleague should not have done that
      • Well... if you had taken the medicines as advised this may not have happened
    • Evasive - Do not be evasive to their questions or appear to be covering up mistakes. A lack of a concise and clear explanation may appear evasive.
    • Reflect body language – Avoid emulating or reflecting upon the patient’s body language
      • You look very angry at the moment
  • Offer an apology to the patient 
    • Apologise even if you feel the complaint was not warranted and this should be offered as early as possible where appropriate. 
    • This will demonstrate empathy and often diffuses hostile patients… 
      • I am sorry for the experience you have had…
      • I offer my sincerest apologies…
      • I am sorry that happened to you… Tell me more about that…
  • Acknowledge & empathise with the complaint 
    • Acknowledge the complaint & empathise with the distress it has caused. 
    • Show appreciation to the patient for raising the complaint if it is of a serious nature.
      • I can see that must have been very distressing for you… 
    • I can imagine that it must have been quite difficult for you…
    • It must have been very hard for you…
    • I can understand why you are angry about it…
    • I am grateful that you have brought this to my attention…
  • Clarify the patient’s expectation
    • Clarifying with the patient what they were hoping for from the complaint
      • How were you hoping we could address this problem? 
      • Was there anything in particular you were hoping for?
  • Offer an explanation if appropriate 
    • Provide an honest explanation summarising the series of events. 
    • If a mistake had happened then inform the patient as to how and why it occurred. 
    • If there are some mitigating circumstances surrounding the mishap then these can be stated without justifying the mistake.

  • Preventing the complaint from happening again
    • State what immediate measures you have taken to rectify things and minimise the distress caused to the patient. This may include preventing the mistake from happening again i.e. significant event analysis, practice audit, practice protocol, education event/retraining for the clinician, adding alerts to notes etc.
    • Do you want me to speak to the person (doctor) directly?
    • I can raise this at our practice meeting as a significant event
    • How about if we have a conference with everyone involved including the practice manager to discuss this matter further?
    • I will set up a practice protocol or audit to prevent this from happening again
    • We will update the computer so this error cannot occur again

  • Offer to escalate to complaints procedure
    • If the patient is still angry explain the practice’s complaints procedure to the patient. Do not simply tell the patient to speak to the Practice Manager and they will sort it out. Offer to ensure that the patient’s complaint is seen through and offer to take personal responsibility if appropriate.

ESTABLISH THE COMPLAINT & APOLOGISING
I am really sorry for what has happen. Please tell me more about it so that I can help you…
I am sorry for the experience you have had or I apologise this has happened to you…


EMPATHISING AND ESTABLISHING EXPECTATION
I can imagine that it must have been quite difficult for you…
How were you hoping we could address this problem?


MANAGING THE COMPLAINT
I can imagine that it must have been quite difficult for you…
You mentioned… it is possible that it happened because…
We can try to prevent this from happening again by…
If you still feel upset by it I am happy to run through the complaints procedure with you