Episode 51 Effective Patient Communication – Managing Difficult Patients

If you believe that coping with some of the people we deal with in emergency medicine is difficult or impossible, you’re not alone. We all feel this way from time to time. Managing difficult patients can be a challenge to the health care provider and to the entire ED.  The hostile aggressive patient, the demanding patient, the know-it-all, the excessively anxious patient, and the incessant complainer, are some of the folks that we need to know how to manage effectively. If we fail to handle these patients appropriately, they may receive suboptimal care, grind patient flow to a halt, and delay care of other patients. If the staff has to deal with a multitude of these patients on a given shift, there’s a sort of swarm-based escalation in frustration and sometimes, unfortunately, a total breakdown of effective patient communication and care.

But don't fret.  In this one-of-a-kind podcast on effective patient communication and managing difficult patients, Dr. Walter Himmel, Dr. Jean-Pierre Champagne and RN Ann Shook take us through specific strategies, based on both the medical and non-medical literature, on how we can effectively manage these challenging patients. As a bonus, we address the difficult situation of breaking bad news with a simple mnemonic and discuss tips on how to deliver effective discharge instructions to help improve outcomes once your patient leave the ED.



Prepared by Dr. Keerat Grewal & Dr. Anton Helman, Oct 2014

Cite this podcast as: Himmel, W, Champagne, J, Shook, R. Effective Patient Communication - Managing Difficult Patients. Emergency Medicine Cases. https://emergencymedicinecases.com/episode-51-effective-patient-communication-managing-difficult-patients/. Accessed [date].

Go to part 1 of this 2-part podcast on effective patient communication

The Dangers of Impaired Communication with Difficult Patients



Impaired communication with difficult patients can lead to a vicious cycle of attacks and counteracts. You may inadvertently direct negative actions towards the patient, who in turn, may feel abandoned. This creates an ongoing cycle of poor communication. Effective communication is vital to breaking this cycle and moving toward solution focused actions.

First Line Techniques in Managing Difficult Patients



* Gain personal emotional control: Don’t react, be proactive, and know your triggers. Slow down your breathing, speak slowly and quietly, lower your tone, and think about your body language. When feeling frustrated or angry, try reciting to yourself a few times: “I’m alert, I’m alive and I feel good”. Although this may sound someone ridiculous it can be an effective technique in shifting your 'flight or flight' amygdala-mediated physiological response to a positive, calm and constructive state of mind.

* Start with a good first impression : Smile, use an open posture, introduce yourself, extend your hand for a handshake, look patients in the eye for 3-5 seconds (see Episode 49 on Effective Patient Communication)

* Help your patient get emotional control: Don’t argue (arguing will lead to a vicious cycle of attacks and counterattacks as described above). Patients want to feel heard, understood and validated. Say "I'm here to help you and hear you out".