'Step away'—When patients make you furious
Key Takeaways
I'll never forget the time I lost it with a patient.
Mr. K. was a 37-year-old male who I saw in my clinic for uncontrolled type-2 diabetes. Every time he came in, his HbA1c and rapid glucose were off the charts. He had multiple hospital admissions for diabetic ketoacidosis, and already had two toes amputated due to severe peripheral arterial disease, a known diabetes complication.
One day, a surgeon called to inform me that Mr. K. was in the hospital and would be undergoing a below-the-knee amputation (BKA) due to extremely poor circulation as a result of poor glycemic control. The surgeon initially tried to blame me for not having my patient on the proper diabetic regimen. I explained that I had consistently tried to work with Mr. K., and he was stubbornly non-compliant with his diet and insulin regimen.
A couple of months after Mr. K. underwent his BKA, he came into my office for a check-up. His abnormal labs indicated injured kidneys, and his sugars were uncontrolled. He told me he ate a donut for breakfast, skipped lunch, and was unsure how many units of insulin he gave himself the previous night.
My temper exploded
I was so disappointed—not only in his lifestyle but in his nonchalant attitude about his health—that my disappointment turned to anger. I snapped at him and told him that if he continued on this path, he would soon need an above-the-knee amputation, and most likely I would not continue as his physician.
We exchanged a few harsh words, and I knew I had overstepped my boundaries and let my emotions get the best of me. I walked out of the room to collect my thoughts, and returned to apologize, explaining that my anger and frustration stemmed from feeling helpless that he wasn't following my medical guidance which, in turn, made me feel that I was failing him as a physician.
Doctors can get angry, too … Here’s why
Oftentimes, our anger is due to patients not listening and being non-compliant, and we become exasperated because it is our duty to help them. But we cannot help them if they are not willing to help themselves. As a result, we feel we’re not doing our jobs as doctors and take out our frustration on the patient.
As physicians, there are many issues that weigh heavily on our mental health, potentially resulting in exhaustion, irritability, and anger. The increasing corporatization of medicine, medical school debt, the distorted compensation system, the loss of physician autonomy, and the loss of trust and integrity in the patient-doctor relationship are a few factors that may fuel our anger.
The pandemic has amplified these factors and added even more stress, insecurities, and trauma for those working in medicine during a global health crisis. It is not surprising, therefore, that this cumulative stress has strained our ability to manage our emotions.
Anger is typically considered to be a secondary emotion, meaning that it occurs to counter feelings of loss of control, depression, powerlessness, low-self esteem, and exhaustion in the face of overwhelming personal stressors. When used appropriately, anger can be an effective compensatory mechanism, but oftentimes it is extremely harmful to us individually, and particularly to relationships with our patients.
"We are in this field to protect, advocate, help, and heal our patients, so when we become angry with them, even if it is justified, it is our duty to address this anger. "
— Kristen Fuller, MD
Practice empathy to improve compliance
Research has shown that a lack of empathy from physicians toward patients has dramatically led to patient non-compliance.[] As a result, physicians are becoming frustrated because their “patient is not listening to them.”
To prevent this frustration and anger and improve patient compliance, research shows that physicians who practice empathy through the following methods can increase patient compliance:
Recognize your own emotions during a patient encounter.
Attune to the emotional messages in your patient’s story.
Attend to your non-verbal communication.
Accept negative feedback from patients, and reflect on your emotions.
What to do if you lose self-control
When you feel you may be losing your temper, here are some methods to keep it in check and avoid heated patient interactions:
Step away to gather your thoughts. Remember that most patients do not have a medical background; they do not understand this stuff.
Bring a nurse into the room with you as a buffer when you come back to apologize and explain why you became angry.
Consider therapy, as you may have some underlying triggers that need to be addressed.
Do not fuel your anger with drugs or alcohol.
Each week in our "Real Talk" series, mental health advocate Kristen Fuller, MD, shares straight talk about situations that affect the mental and emotional health of today's healthcare providers. Each column offers key insights to help you navigate these challenging experiences. We invite you to submit a topic you'd like to see covered.