Urgent care centers are fertile ground for angry patients. Our patients are often sick and in pain, they often have long waits to be seen, and they are frustrated by an inefficient healthcare system that has landed them in urgent care in the first place.
Additionally, most of our patients are starting a new relationship with us, and they have not yet built any trust. Their prior healthcare experiences are most often lousy at best, and replete with hurdles and aggravation. They are used to being given the run-around, so they’re coming in with “dukes up,” ready to fight. Couple a battle-ready patient with a poorly prepared urgent care staff, and you have all the ingredients for a real scene.
They key to avoiding a full scale wat in any conflicts is “de-escalation.” De-escalation skills are mature coping skills that most of us have never learned. The majority of us learned out coping skills on the playground at school: “I’m rubber and you’re glue! Everything you say bounces off me and sticks to you!” When someone came after you with fists clenched, you got ready to punch back.
We have translated these playground lessons into our everyday lives as adults. I can freely admit to being ready for a fight every time I walk into the Department of Motor Vehicles. Unfortunately, many of our patients have the same feeling about healthcare institutions, so when they walk through our doors, they are preparing for a battle.
Understanding the root cause of hostility is the first step toward a path of de-escalation. Let’s review a few others here:
- You may not think you instill fear in your patients, but most people are, in fact, afraid of seeing doctors. In addition, they are often afraid that their condition may be something very dangerous. It may seem obvious to the practitioner that a patient’s chest pain is simply reflux disease, but you can be assured that patient thinks he is having a heart attack and is scared to death about it.
- Nothing makes for better “anger food” than pain.
- A patient is coming to your office with a life’s worth of bad experiences in healthcare.
- The healthcare-and-insurance maze is one of the most challenging bureaucracies one will ever have to navigate. I have yet to see an insurance bill I understand, and I’m still trying to figure out what all my deductibles, copays, and co-insurances mean. I have to laugh when I hear office staff say, “Well. it’s your responsibility to understand your benefits.”
- Let them “blow off steam.” During the peak of an anger reaction, there is no way you are going to be able to reason with them, so don’t try. Resist the urge to react to everything they are saying. Just stop and listen. Remember, their anger is not directed at you, so don’t take it personally.
- Eventually, the anger runs out of “steam” if it is not provoked.
- Once they slow down, you have an opportunity to get the train back on the tracks. This is where you say something supportive like, “I know how frustrating this must be for you.” This does not mean you agree, but it shows understanding and validates. Nothing works better than validating to diffuse a situation and build trust.
- Once they calmed down, you have the opportunity to problem solve, which is what everyone really wanted in the first place. If at any point you begin arguing with a patient, the whole process derails and escalations resumes.
Finally, if you feel unable to control a situation, get help from a colleague. Sometimes, a new face and a new pair of ears can be the difference maker. Again, don’t take it personally.
In future columns, I will discuss other tips that help you provide exceptional customer service, even in the most difficult of circumstances.
Lee A. Resnick, MD
Editor-in-Chief
JUCM, The Journal of Urgent Care Medicine
Adapted from the “Hostility Curve” as presented by the American Hospital Association. Teaching Patient Relations in Hospitals: The How’s and Whys. 1983.
