Dealing with Difficult Patients and Their Families Key Terms

Transcription

1 Dealing with Difficult Patients and Their Families Key Terms Term Definition Introduced In Active listening A communication technique where the listener is engaged and entirely focused on the patient Module 3 Assertive communication A communication style where one is confident and expressive; regards the feelings of others and self Module 4 Empathy An ability to understand complaints impartially; a focus on acknowledging emotion Module 4 Magnifier Any trigger that intensifies emotion such as pain, fear, or confusion Module 1 Paradigm shift A significant change in the pattern of thinking or understanding Module 1 Verbal The third V of a consistent message; the means of communication through tone Module 2 Visual The first V of a consistent message; the means of communication through body language Module 2 Vocal The second V of a consistent message; the means of communication through words Module 2 Glossary page 1

2 DIFFICULT PATIENTS MODULE ONE UNDERSTANDING DIFFICULT PATIENTS Female: As I mentioned earlier, patients don t set out to be difficult. They become difficult through the process. And unfortunately with all the demands placed on our healthcare professionals today, sometimes dealing with that difficult patient isn t always as easy as it could be. I mean consider we ve got a high-paced environment, we ve got tons of demands from a lot of new laws being implemented, sometimes you re short staffed, sometimes budgets are tight. Sometimes, if you think about it, we joined the healthcare industry so that we could help. And sometimes we don t get to do that. Sometimes we re in a position where we can t help. And that can be extraordinarily frustrating. But add on top of that we get patients that are difficult. And that can just be the straw that breaks the camel s back. So it s important that we remember why we chose our industry and why we got involved with the industry in the first place. For many of us, that was a desire to help. That was a desire to do something good. So we do want to keep that in mind, but we also want to remember that it s a business decision to be able to handle difficult patients. See, when we let patients get to us, our ability to serve the patients who are not difficult diminishes. We re not as healthy ourselves. We become stressed out. And when we become stressed out ourselves and we start getting sick, we can no longer help the people that we got in business to help. So as a business strategy, when we learn to deal with difficult patients, not only do we have happier and healthier patients, we end up with less stress at Page 1

3 work. There s lower turnover, and this leads to happier and healthier staff. So it really is important that we understand a paradigm in order to be able to handle these difficult patients so we ve got a chance in order to help the health of the entire environment that we re working in. Now Stephen Covey tells an interesting story. And it really helps us to come back to remembering our paradigm. A paradigm is just a pattern of thinking. Sometimes if we ve been in an industry for a long time, we have one pattern of thinking. Maybe we ve gotten a little hardened. Maybe we ve gotten a little frustrated with our patients. And the story illustrates remembering we don t always know what s going on behind the scenes. We may see a patient and we may think we know. We may be guessing. But we really don t know what s going on. In the Seven Habits, Stephen Covey tells a story of a man coming on to the bus. He s got three kids with him, and the kids get on excuse me, a train, not a bus. The kids get on the train and they re out of control. The man s not doing anything to control them. They re running up and down. They re disturbing lots of passengers. And the man just seems like he s in another world. And Dr. Covey says to the man, Sir, can t you see that your kids are really running around here? Can you do something? And the man stops for a second and says, I m so sorry. We just came from the hospital and they just lost their mom. And you can imagine how that affected Dr. Covey. His whole paradigm shifted. He didn t know what was going on in that gentleman s head or heart or mind, and to find out he just lost his wife and the mother Page 2

4 of the three children, it really changed the paradigm. So I want to encourage you that as you re talking to patients, seek first to understand them. We don t always know what s going on behind the scenes, or what is going on in their paradigm. But we need to have a paradigm shift in order to be able to take that step to try to understand them. And our paradigm shift really is to have an attitude of service. We re really here to serve that patient. And part of serving that patient is to help them with their needs. Now do they always ask in the most polite way? Of course not. Are they sometimes rude? Are they sometimes demanding? Of course. That does happen. But we always want to remember where our job is. And we re doing more than just our job. It is really having an attitude of service. I m here to help you. And I m here to help you move forward in your medical and mental health, of course. So we want to start with first seeking to understand. What s going on with this specific patient? Maybe they had a bad experience with a previous medical faculty. Maybe they just lost a loved one. There s a lot of things that can happen. But we want to take the time to first understand and not make assumptions about that patient that may put us on the wrong paradigm. Part of that is understanding there are magnifiers. What magnifiers are is anytime we are experiencing maybe a stressful situation, these items can intensify our emotions. When that happens to a patient, somebody who is normally very controlled, normally very pleasant, normally very easy to deal with, all of a sudden becomes very uncontrollable. They become Page 3

5 demanding. They become a difficult patient. And some of the magnifiers you re going to watch out for is pain. A lot of times when somebody s in pain, they end up not being so nice, and we know that. And a lot of times they may not indicate that pain or they may not know they have pain prior to experiencing the outburst or outbreak. There may be fear. Maybe it s the fear of the unknown. Maybe they don t know what s going to happen. Or maybe it s the fear of the known. Maybe they do know what s going to happen. Maybe they ve dealt with the disease or disorder with a family or friend and they kind of know what s coming up. And that creates fear. That can intensify their emotions, and consequently make them a more difficult patient. Confusion is another one. This is one we want to keep an eye on because a lot of times, especially in an older demographic, you may find that an older patient couldn t hear you. And because they couldn t hear you, they became confused. For example, you may have a patient that you clearly explained when and how to take their medication. But a family member comes back with the next visit and says, Well you never told my mother how to take her medication. Well, you may have told her and you may have explained it very clearly. But you may not have realized that the mother was not comprehending. She was confused. Or maybe, and this can happen as well, the hearing has gone. Because the individual didn t hear you, she didn t even realize you were saying something. So it s something we need to be a little bit more aware of when we re working with our patients, is to check their comprehension. Page 4

6 Now Miss Adams, can you share with me how often you need to take your medication? Let them repeat that back so we make sure that confusion is not an amplifier or a magnifier for their frustration, which turns them into a difficult patient. Of course it could be that they re missing work. Maybe you ve got a patient that is being held up for some medical treatment and they can t get to work and they re frustrated because of that, and because certainly they may be the type of employee that doesn t get paid unless they are working, which would cause the next one which is money or lack of money. This could be a magnifier as well. Of course insurance, healthcare insurance is a big magnifier today. And personal issues you don t know what s going on in their personal life. They may have had a severe fight with a spouse. Maybe they ve had issues with their children or grandchildren. There s all kinds of magnifiers that can magnify their emotion, and consequently turn an average, normal patient someone who s happy, go-lucky, they re okay any one of these could easily push them over the edge into being difficult. It s our job to take a few minutes and to understand what s going on. So again, first seek to understand. And then be understood. So a couple of things we want to consider when we ve got a difficult patient is first, did I cause this? Is it possible that you as a healthcare professional were one of those magnifiers? Were you having a bad day? Were you maybe not as polite as you could have been to that patient, and did that create a magnifier? And then the second thing I want you to consider is how can I diffuse this? Page 5

7 Because it s really not about being right. It s not about showing them who s smarter. It s not about telling them, you know, giving them a piece of your mind. It s really about having an attitude of service. So how can I diffuse this? How can I reduce the stress? How can I bring this back down and move forward? So our next modules, we re going to go over that very, very specifically. [End of recording.] Page 6

8 DIFFICULT PATIENTS MODULE TWO IMPROVING YOUR COMMUNICATION SKILLS Female: Module Two Improving Your Communication Skills. Let s talk about our communication skills. Let s try to remove ourselves as part of the challenge so that we know that we re not the ones as their magnifier. It starts with delivering a consistent message. You might think, well of course I m consistent. I tell them exactly what they need, when they need it, and I m very consistent about it. But I want you to consider that your message actually has multiple parts to it. And if you re not aware of this, what you might find that is happening is that your message is consistent in your words, but maybe not your actions or your tones. So let s go over the three Vs of a consistent message. First is Visual. Is visually what you re saying matching what you re meaning? In visual, I mean your body language. Imagine that you had a nurse - and maybe one of these three in the image here if you re watching our video - very casual, very laid back, very relaxed. And they say, Okay, Mrs. Smith, we need you to go ahead and stand up. Nothing too difficult. But now all of a sudden, if one of them crosses their arms and starts to look down their nose, it can now become a very demeaning demand instead of a simple request. So we have to make sure our body language matches our message. This also means, and here s a tip here as well, is make sure that you bring your eyes above the clipboard. Too many times we ve got our nose in a clipboard and we re talking behind the clipboard, and it s very difficult for a patient to see us. So we need to be making eye contact. That s part of Page 1

9 our body language. We also want to be careful not to cross our arms. This can become a very defensive stance. It can be interpreted that way. So it s important that our visual body cues are consistent with our message. If our message is to be of service, we want to have a service body language. Now the second consistency is Vocal. And you might think, Well of course I m consistent. I tell them the same thing each time. That s not what I mean. By this vocal, what I mean is we kind of use words that they understand. I understand our a medical professional, and I understand you have certain lingo and certain jargon that you re going to use. But to the average person, it just sounds like, Blah, blah, blah, blah. They don t understand. And when they don t understand, they become confused. And when they become confused, this is a magnifier and now they can become more difficult. So we want to reduce the amount of confusion. Now as we go through our training today, I want you to get a buddy. I want you to find somebody else that you can partner with that can kind of watch you through the next 7 to 14 days, and I want you to ask them, Am I doing that? Sometimes we don t even realize we re using very specific language that to us is normal. Of course we know what that means. We re in the medical profession. That s what we talk all day long. That s what everybody we talk to talks all day long. But here s the challenge your patients don t. And if you re consistently using jargon, they don t understand, you could be a magnifier. You could be creating some confusion, which in turn turns them into a difficult patient. So it s Page 2

10 important that we want to try to reduce the amount of jargon. It s not their everyday language. So have a coworker listen and see if there s any specific words that you re using that might be confusing your patients. And remember, a patient doesn t want to seem stupid or dumb or uneducated. So they might not say, Well wait a minute, I don t understand what that means. They re just in their head going to become confused. And when they become confused in their mind, they start to get irritated, they start to get frustrated, and now you start to see them become resistive and defensive and it becomes a difficult patient. So remember, use simple language that they can understand, and have your buddy help you with this one. Now the last V so the first was Visual. Then there was Vocal. And then there was Verbal. With Verbal, that s your tone. So I want you to monitor your tone. And I know you re busy. I certainly have worked with many healthcare professionals, and I know time is of the essence. I spoke with one doctor who had exactly seven minutes for every single patient. You can imagine that doctor was flying from one room to another, and they were getting frustrated. They were frustrated with the system. The doctor was frustrated with the system. The problem was the patient didn t know anything about the system. And when the doctor was coming into the room to speak to the patient, all the patient heard and saw was a frustrated doctor. And consequently, that was becoming a magnifier to create difficult patients. So monitor your verbal tones. Are you speaking too fast? Remember, oftentimes people Page 3

11 are frightful. They are fearful, especially if they re getting back medical results. Slow down. Make sure that they can understand you. Now of course they re not stupid. So you don t have to talk to them as if they don t understand anything. But slow down a little bit to give their brain a chance to process the information that you re bringing at them. Because oftentimes that information is coming very, very fast. Even though for you it s very slow, for them it s going to be very, very fast. Oftentimes patients say, Well, I don t remember what the doctor said. They said it so fast, although for the doctor, it wasn t very fast. But for the patient, it was very fast. So vocally monitor your vocal tones. Make sure your tone doesn t seem condescending, doesn t seem intimidating. You want to be able to connect with each of your patients. So here s what s interesting. Do you know which makes the biggest impact? It s your body language. 55 percent of your communication is your body language; 38 percent is your tone; and only 7 percent is your words. So if you were to come and talk to a patient and a very rough tone because you re rushed and your arms are crossed, and you were saying, I really care about you, and I want to see you get better, Mrs. Smith. You know that? They re going to read your body language and your tone much more over your words. So it s important that we, of course, use appropriate words. But it s more important or excuse me, I shouldn t say it s more important. It s also important that you monitor your tone and your body language to make sure that you re really communicating the message that you want to be Page 4

12 communicating. Just take for example, if you look at these two images, one with the arms crossed and one with the arms open, patients will tell you the one with the arms open is more welcoming and friendly. So it s important to manage your body language and make sure that you re not crossing your arms or doing anything that could be seen as defensive or shutting down. You want to be able to listen and to be able to actually hear what the patient is saying. Now of course effective body language, a couple of things you want to be aware of here. Oftentimes if you re standing and a patient is sitting or laying, this could be seen as intimidating. You are now taller than the patient. And the patient can see this as you looking down on them. Many reception desks have not been adjusted so that the receptionist is at eye level with the person who is coming up to the desk. So it s important for you to be at the same level. This makes you seem as an equal and does not produce the negative results. Again, we talked about avoiding crossing your arms. In general, monitor your own body language. Have your partner, your buddy, while they re monitoring your visual, vocal and verbal, make sure they re monitoring your body language to make sure you re not doing something as simple as tapping your toe as you re sitting there and writing about the patient. That can be seen as a frustration. It can be seen as nervousness. So we want to make sure that our not communicating the wrong message. But have your buddy watch out for that. And then of course do the same thing for your buddy. Make sure that they re not Page 5

13 communicating the wrong message. And sometimes these things that our body does, we re not even aware of them. I had one nurse that always scratched her nose. She was always rubbing her nose. And rubbing your nose is a psychological sign for lying. So it was important that we noticed it and we stopped her from doing it, and she started to have less issues with her patients. People pick that up. So you want to make sure that you re paying attention to these little things. It s these little things that sometimes can be the little triggers that are magnifiers that cause your patients to become very difficult. Now we talked about making your words count. Because you ve only got 7 percent of your messages going through your words, the rest is going through your tone and your body language. Your tone includes your pitch, your power, and your pace. Now what s interesting with pitch is as people, at least in our culture, the lower your pitch, the more trustworthy and the more authority you will seem to have, which sounds interesting and strange. Have you ever considered this example? Have you ever called somewhere and the person answers and says, Hi, this is Susie. Can I help you, please? She had a really high pitch. Some of us might find this really, really, really uncomfortable. What happens is the lower we can drop our pitch, and just relax your vocal chords, the more you can drop your pitch, the more trustworthy and authoritative you re going to sound. That requires you to relax your vocal chords and just relax. Now of course, we don t want you to go artificially low and try to get it down really, really low. That s not what Page 6

14 we re talking about. We re talking about just practicing practicing taking it from in your nose to in your chest. And that might take a little bit, especially if you ve spoken from a nasal if you have a nasal pitch, or you re running it through your nose, you re going to notice it s going to take a little bit. But over time, you can slowly, slowly, slowly bring your pitch down. And you ll seem more authoritative when you do that. Now the second is power. That s your volume. You can use the volume to take control. See, imagine have you ever fought with someone and they continue to speak in a lower volume? They don t get upset. They don t get mad. This can actually calm down an argument. So the lower the volume, the more soothing your tones, this can create more trust. Now you have to be careful, though, because some patients can t hear well. And sometimes they re too embarrassed to ask you to repeat things, and of course this adds to the confusion and fear and could even get worse when they tell family members that you never answered them when in reality, they just never heard the answer. So you have to be really careful with your power. But you want to be careful not being too powerful. Because what happens is when you get too powerful, you can seem overbearing, intimidating, and people just don t want to talk to you then. Did you notice that? So you want to make sure your pace is a little bit slower as well. When you put together a higher power in other words, higher volume and a faster pace, you become unapproachable. And that s when patients stop asking questions. They start to get more Page 7

15 confused and you start to see more difficult patients. So in order to make your words count, you want to make sure to have a lower pitch, a softer power, lower volume, and a slower pace. And if you can combine those three things, you ll start to see that your patients will react just a little differently. And the more you calm down and the more you bring your vocal energy down, you ll notice that your patients will be less frustrated, less upset, and you ll have less problems with them. Now there are some words that you re going to want to avoid in order to get the most out of this. These are words that are weak, and they can cause some patients to want to challenge your authority. The first is, I ll have to... "I ll have to get the doctor to sign this." Instead of saying, I ll have to, why don t you just say, The doctor will sign this and I ll call you immediately. I can t... That s another word you want to try to avoid. I can t get you in until tomorrow. Instead of focusing on what you can t, simply focus on what you can. So instead of, I can t get you in until tomorrow, how about, I can get you in first thing on Monday. Instead of, I don t know, how about, Let me find out. We want to be more positive. Remember, this is an attitude of service. We talked about that being our paradigm. It s not my job. Certainly the patient doesn t understand maybe what is your job and what isn t your job. So how about instead, I ll check with Judy and get right back with you. Real simple. How about, No one told me. How about instead, try, Now that I have this information, let s move forward. We re looking to move the patient forward. We re looking to serve them Page 8

16 not fight about who s right or who s wrong. It s not really about that. How about, You ll have to wait. Most patients will understand waiting, but how about saying it a little differently? How about, We have two patients ahead of you. As soon as they re done, we ll be ready for you. Real simple. I ll try this is one you just need to remove completely. Don t try. As Yoda said, There is no try. There is only do or do not. Try is really an excuse for failing, in my opinion, and I know that s strong language. But here s what I ll tell you. I ll try gives you the excuse that if you can t get to it or don t do it, that you ve got an out. Well, at least I tried. Just do it. If you can t do it, don t promise it. It s that simple. But avoid the words, I ll try. And lastly, my all-time favorite, It s our policy. Policies are written for certain purposes. And if there is a policy in place - and I understand that there are many policies that you do have to follow. We get that. Patients understand that, too. Instead of saying it s our policy, consider why that policy is in place. Is it because of a law that requires that? Is it for the patient s safety? Is it for the staff s safety? Tell them that instead. Instead of saying, Well that s our policy, how about something like, Well for our patients safety, or, As we re required by law. Give the real reason not just the policy. A policy is just a set of written words that can be changed at any given time. Go deeper to the real reason, and you ll find that you get a lot less objections from your patients when you tell them that. Now a few reminders make sure your tone and your volume match. If you re trying to be if you re in a soothing Page 9

17 tone, make sure your volume is a little bit lower. And make sure reflect what they do. Don t react if they get sarcastic. Reflect what they do. And what I mean by that is if they re excited, it s okay to be a little excited. If they re a little down, drop your energy. Be a little down. If they get sarcastic, do not get sarcastic back with them. That s important. Just ignore it and move on. Ignore the negative that they do and focus on the positive. Of course you re going to remove any barriers. If they do start to get difficult, you may want to remove a barrier between you. If they re sitting behind a desk, come around from the side of the desk and sit. Be careful of fact listening. What I mean by fact listening is sometimes we listen and go, Uh-huh. Uh-huh. Uh-huh. It s almost as if we re just listening for the facts. We want to be actively listening paying attention to what they re saying, and maybe not maybe even not what they re saying, but how they re saying it. And of course we want to repeat back what they told you and get confirmation that what they re saying is what we re hearing, because certainly listening is a two-way street. We ll get more into that in just a minute. [End of recording.] Page 10

18 DIFFICULT PATIENTS MODULE THREE ESTABLISHING TRUST Female: Module number three Establishing Trust. In a healthcare environment, our patients must trust us. If our patients don t trust us, they end up questioning what we say. They re resistant. They re defensive. And today with the Internet providing so much information, it s highly likely that our patients have gotten misinformation, and consequently if they don t trust us, they can become very argumentative, making our job even more difficult. If you consider, a family member might even be the one who distrusts you most. Why might that be? Well here s a couple of reasons why the family member might be even more difficult than the patient. First it s their magnifiers. Remember, it s their loved one. They care about them. Imagine you re in a nursing home and the family comes in to see Grandma, and Grandma s got a new bedsore. You can imagine if they ve seen this before, or maybe 20/20 just ran a whole series on abusive nursing homes and bedsores was the keyword they kept hitting on, you can imagine that s a magnifier for this family. Now when they come in and see this, the first thing, Oh no! Oh no! Not Grandma! Not this nursing home! And it s a magnifier that suddenly gets in their mind, and now they become the difficult family. So we have to be aware that there s magnifiers that apply to the families as well. Of course it s their paradigm. It s the way they think as well. Maybe they think care is supposed to be done a certain way. And maybe the paradigm that your facility uses doesn t match the paradigm of the family. So you could see right there, Page 1

19 that could create a distrust. It could be cultural. It could be the way they do things in their culture is different from the culture of the care environment that they re in. It could be other experiences, maybe that a family member or a friend had something happen and now that s intensifying their emotion. It could be we mentioned this Internet misinformation. It could even be the patient misinformation. It could be, like we talked about earlier, the patient not telling the family the appropriate information. It could be miscommunication. So it s important that we understand that people don t set out to be difficult. And the family truly does care about their loved ones. So sometimes being difficult is really an over-emotion reaction. So we want to take a look at what can we do to build trust and remove barriers? Building trust starts with maintaining eye contact. It s being confident and comfortable in front of the family, staying focused. And a trust barrier would be fidgeting. Sometimes when we re nervous, and especially when we get angry or aggressive family members, it can be very difficult. And we might fidget. We might feel like we re on a hot seat literally. So it s important that we stay focused and that we maintain eye contact. Taking notes is a trust builder, but we have to be careful that we don t get our head buried in paperwork, especially with today s clipboards or if you ve got an electronic device that you re using. It s easy to get ourselves caught up in that and forget to maintain eye contact. A trust builder is considering the emotions. Sometimes, though, we re on a tight time schedule. And I completely get Page 2

20 that you might be understaffed. You might be running on a seven-minute time budget. And you ve got to get things done next, next, next, next. But we need to slow down just a little bit, consider their emotion, and make sure that we re considering their intent. Getting the gist is no longer enough. That can quickly, and often does, create barriers for us. We need to pause before we reply. And I know in a fast-paced environment, it s hard to pause before you reply. You knew the answer three seconds ago, four seconds ago, five seconds ago when the person was talking. Why do you have to pause? I understand. But when you pause, it shows a thoughtfulness and a consideration that often the patient and the family needs. So you absolutely do not want to interrupt. This is a big no-no. When we interrupt people, it s almost as if we re saying, Silence. Your voice doesn t matter. And it is interpreted that strongly, especially in the medical profession. So it s important that we do listen, that we re not preparing our answers, that we re really listening to their words, and we re asking questions to clarify. And of course then, we re pausing before we reply and we re waiting until they re done to give them the answer. Remember, we need to look from their prospective and allow them to finish. Now of course we need to give them our full attention. It s easy to get caught up in multi-tasking. And I know many of us have gotten very good at doing three things at once. But it s important if we want to build trust, especially with the family and the patient, that we do need to give them our full attention. Now in building trust, we need to make sure that Page 3

21 the patient understands the process. Sometimes confusion can occur simply because a patient doesn t know what to do when they re frustrated. Have you ever especially ladies have you ever been in a medical faculty when you ve been asked to change into a robe, they do the exam, and they leave and you have no clue what you re supposed to do? Am I supposed to get dressed? Am I not supposed to get dressed? Who am I supposed to ask? Do I go out there in this and ask? You sit there and you start to get frustrated because you don t know what to do. A simple little sign like, Okay, we re all done. You can get dressed now, will help to let the patient know the process. So remember, you work in a medical faculty. The patient doesn t. They don t know what the process is. So it s important that you share with the patient, Okay, we re going to do this, and then these are the next steps. Give them one or two steps next. Sometimes posting signs can help as well, especially any policies. If the patient is going to be sitting in a waiting room or an exam room any period of time, post some signs about your policy. This will help them to understand what s going on. For example, a sign as simple as, You will not get a call for normal test results. This is really something very simple and basic, but it reduces the number of calls, and it helps the patient understand the process. And lastly, you re going to listen to more than their words. Patients will communicate things in their voice, in their tone, and in their emotion. And sometimes they don t give us everything and all the information we need. We have to ask more questions. And it comes Page 4

22 out in their tones and again in their emotions. But see, all of this starts with taking the time to listen. And I know you re already stressed. I know there s a lot of things already going on. But this one small item of listening not answering too fast, not interrupting, not cutting them off it s the listening that will allow them to feel heard. We want to remember in listening there s two sides. There s the person communicating and what they re saying, and then there s what you re hearing. And when we re hearing things, we re putting it through multiple filters. Those are the filters of our life and the things in our paradigm and the way that we operate. So it s important that we listen. Then we also reflect back what we heard them say. Oftentimes when a patient is frustrated or annoyed or irritated, it s not because the caregiver didn t provide the information. It s because they didn t feel like the caregiver heard them. So let s walk through a couple of ways that your patients can feel heard, because sometimes it s not enough just for you to answer their question. They want to feel as if you ve heard them. So it starts by maintaining periodic eye contact. You want to be able to concentrate on what they re saying. This means not talking to someone else, not looking down at your clipboard, not looking at your smart phone. Whatever else distractions, pay attention to the patient. Next is you want to avoid nervous gestures. I sometimes have a bad habit of picking at a nail. When I get nervous or frustrated, or I want to move on, or I ve got six other things to do and someone is moving way too slow for me to handle them, my nervous Page 5

23 gesture comes out and people read it. They see it and consequently, that nervous energy projects into them, and they become more difficult for me to work with. So it s important that we monitor our own nervous gestures. And you know what s interesting? I didn t even know I had a nervous gesture until someone else pointed it out. So if you re working with your buddy to become better at your skills, you want to ask them, Do I have a nervous gesture? And what s strongly enough, you may find that you do have a nervous gesture that you weren t even aware of. Now another way to help people feel heard is to remove physical barriers. What I mean by that is sometimes there s a table in the way. Sometimes there s a desk. Sometimes it s even your own clipboard. You need to set that down in order to have that direct communication with them so that they feel as if they ve been heard. But of course, ask questions so they have a chance to share a little bit more. Now especially if you re feeling rushed, you may pick up that they re going to be feeling rushed. So you may have to slow down just a little bit so that they can feel comfortable asking questions and answering your questions as well. We talked about body language earlier. We want to use open body language. Avoid crossing your arms, crossing your legs, anything that says I m not interested, I m not paying attention. Repeat back what they ve said to you. Make sure you re hearing them properly, especially if they re getting a little frustrated. Sometimes people say things when they re frustrated and they really don t mean them. Or they ll say something and they ll realize, Oh, that s really not what I Page 6

24 meant. But once they ve said it, it s hard to take it back. So repeat it back and say, Is that what you mean? Is that correct? And remember to take things from their point of view. If it s possible, feel free to take some notes. Now in some cases, it may not be possible. You may not be able to have the ability to take notes. But if you can, show that you re listening. Show that you re paying attention. They'll feel heard and you ll have a lot less frustration with your difficult patients. A couple of tips here, make sure you re actively listening. That means don t be thinking up your answers. Don t be thinking about how you re going to answer it. Just listen to what they re saying. Use listening, you know, the head nods and anything that s appropriate that shows them that you really are listening, and of course periodic eye contact. Look for hidden meanings. Sometimes people will say something and you go, Hmm. I wonder what that really meant, because there wasn t really a direct comment, but there s a hidden meaning behind it. So do consider that when you deal with the unspoken concerns. And keep in mind, sometimes people they get frustrated, too. And sometimes they say things and they are ways that, you know, they aren t normally. So don t hold it against them. We ve all had a bad day, or we ve all said something and said, Man, that wasn t me. And our patients have that, too. So it s important that we don t hold it against them. And remember, it s not enough to listen. They want your attention as well. They want to know that you re listening to them and that you re understanding them as well. Page 7

25 DIFFICULT PATIENTS MODULE FOUR ADDRESSING THE ANGRY PATIENT Female: Module number four Addressing the Angry Patient. Now I ve delete with angry patients and I m sure you have as well. And it s no fun. Angry people can be no fun to work with. So let s start off by understanding a little bit about anger because once we can understand a little bit more about anger, we can know how to handle it. Let s start with fact number one. Anger is usually not a choice. It s just a response to a trigger. What I mean by that is if you consider it, consider the last time you got angry. I m not an angry type of person, but every now and then it gets to me. And it really wasn t a choice. I didn t choose to be angry. But somebody hit a button that caused me to be angry. It wasn t my choice. We all have trigger points. You have them. I have them. Your patients have them. So we want to remember that. They re not doing this purposefully. One of their triggers got touched, and we need to be aware of that. When we can figure out what that trigger is, we know how to not touch it again and we can avoid that. Now it s interesting, as a lot of people have the same triggers. So you want to keep an eye open for that to see what those triggers are so you can avoid pushing them and pushing people into that mode. Now once again excuse me, once anger begins it literally hijacks your entire body. It changes your body, your thoughts, it even initiates impulses into action. Anger can potentially hijack a rational thinking part of our brain. Literally I ve heard people say, I m so mad I see red. Well, what s literally happening is the blood is flowing through Page 1

26 their eyes at such an intensity it s turning their world red. Once anger begins, it can be very hard to bring down. So it s important that literally know they are out of control. And they have lost it. So it s important that we remember they re not rational at this point. The feeling of anger is not the same as the expression of anger. This is an important note. Someone can be angry and not express it. They can have it held up in them. In fact if you ve done any studying with the personality types, there s one personality type that literally is like a volcano. It will sit there and their anger will brew and brew and brew and brew. And they can be mad for days and weeks. And I ve even seen a couple of them be mad for months. And you wouldn t know it until that first pop off the top. And then the entire lava comes out. And you had no clue what was even going on. So it s important that we remember there are certain personality types. Xi if you had personality type training, refer back to it because now is the time when they re angry, this is going to come out. Depending on what their style is will tell you how to best handle their anger. Some styles, you just need to walk away. You just need to give them time. Others, you can handle it. But it s important that you know which style that is. Now I want you to know anger is a surface emotion. What I mean by that is underneath the anger, there s often something else going on. It could be hurt, it could be pain, it could be fear. There s something else. It s a surface emotion. So although you re going to deal with the anger and you re going to handle that, you re going to remember anger isn t the Page 2

27 problem. There s something else below it that you may need to explore. Maybe the patient s afraid. Maybe the patient s got some sort of pain, maybe a back pain or some sort of pain in a leg or an abdomen something going on that they haven t told you about, and anger is just the outward showing of it. So if we take a look at that, what causes anger and frustration, a lot of times it can be information overload. If we ve got a patient that we ve just downloaded a ton of information at rapid pace, they may have gotten confused. They all of a sudden got all this information. They don t know what to do. They re frustrated. They don t understand. You re using language they don t get. And it pushes them over the edge. So remember, when you re dealing with individuals especially individuals that are not in the medical field medical terms and terminology can be very overwhelming. Even if you don t think it s a lot of information, consider giving less information, but making it available in another format, whether it s an article they can read later, whether it s an you can send them, whether it s another meeting. Be careful how much information you give them. This could easily push them over their edge. Incorrect information or misunderstood information sometimes there s varying perspectives on treatment. And if one physician or doctor or medical practice decides to go one way, the patient decides they should go another, this could easily cause anger and frustration. So you want to look for signs of that and understand, a normal, clear-thinking individual would understand there s different philosophies. But when you ve got an Page 3

28 angry person, they may not be as understanding. So it s important that we take the time and we understand what the cause of their anger is. It could be that they think they re being disrespected or a family member is being disrespected. Wasting time is another cause of anger. And the biggest one that we see over and over and over again is unclear communication. The patient simply doesn t know what s going on. Something has been miscommunicated. So let s take a look at how we can effectively communicate so that we can reduce the anger, we can reduce the frustration, and we can help our patients get the treatment they need. It starts by setting boundaries. Sometimes we set boundaries too much. Sometimes we ve got the boundaries too closely set. Sometimes we don t set them often enough, and sometimes they re not clear enough, and sometimes we don t know the boundaries. So it s important that we let patients know through our communication what is an acceptable boundary and what s not. And in communication, you re going to find we re born one of two preferred styles. We re either born to speak more passively, which means that we don t talk about the problem, everything will be okay, if we just ignore it, it will go away. You know, that s the flight syndrome when it s fight or flight. The aggressive communicator is the fight. I m going to tell them how it is. I m going to show them. I m going to make it clear. We are born one of these two ways. Unfortunately both of these communication styles are ineffective when it comes to dealing with difficult patients. The passive style, if you ignore it and let them walk all over you, Page 4

29 you re not going to get the results you need. The aggressive style, if you decide to bark at them, they re probably going to be submissive, but you re probably going to lose that patient long term. So neither one of these styles are truly the way to go. But there is a third style that has to be learned. And I will be the first to confess, I love my parents, and my family is an amazing family. But they were not assertive communicators. I was born a little bit more aggressive, and it took me years to learn to be assertive. So let s walk through how to be assertive, because this is one of the keys to dealing with those angry, difficult patients. And it starts with knowing what you want. And you have to be willing to ask for it. Mrs. Jones, I need you to sit down, asking for what you want. Mrs. Jones, please sit down. It s very direct. Not kinda sorta we need you to kind of be over here a little bit more. That s more passive. Or, Sit down right now! That s a little too aggressive. So we have to be more assertive, and assertive again, it starts with asking for what you want. In assertive communication, we use I language. Oftentimes aggressive or passive communicators tend to use you. You need to do this. You need to do that. That s very you based. When we, say, talk in a lot of yous this tends to create a defensive response. You need to do this. You need to do that. People don t like being told what to do. We re dealing with adults in many cases, and these are adults that unfortunately are not looking for someone to tell them what to do. So using I language, I need you to... would be much more preferred. State only the things you Page 5

30 know for sure, what is your side. What I mean by that is, You re mean. Well, that s your perception. That s not really your side. Mrs. Jones, when you try to hit me, that makes me feel as if you don t respect me. That s a different form of communication. You re talking about your side now only versus you re mean. You re mean is giving them a label, and that s not really going to help with your communication. What I mean by setting boundaries is in passive communication, we let people walk on us. People say whatever they want. We just kind of take it. We become a doormat and it s okay. In aggressive communication, we walk on them. You know what? Look, you re not going to walk on me. Here s the way it s going to be. This is what we re going to do. We walk on them. In assertive communication, we say, Okay, you ve got rights; I ve got rights. I m not going to let you walk on my rights, and I m not going to walk on yours. We set boundaries. And this is a learned skill. I know if you re not familiar with assertive communication, this can be kind of frustrating. I know as I had to learn it, it took me a lot to learn. It was so much easier just demanding, Go do this. Go do that, because that was my natural style. But it didn t work, and it created more difficult situations for me, and it didn t help me in order to be able to create the serving attitude that I needed to have. So let s go over the five steps of setting boundaries. First you need to read their emotional problem or excuse me their emotional level. Based on your approach, the problem may have one or more emotional levels. If the emotion is low, then we can skip to number Page 6

31 four and five. But let s just say the emotion is high. The person is frustrated. They re angry. So the next thing we re going to do is we re going to allow them to feel that way. And you re thinking, What? I m going to let them be mad and angry and frustrated? Yes. It s okay that they feel unhappy. We never want to rob somebody of their right to be unhappy. That s not a problem. It s okay to have emotions. And we don t need to tell them to calm down. And here are some really interesting ways that we rob people of the right to be unhappy. We get defensive. Well, you don t need to feel that way, or, You shouldn t feel that way. We minimize the problem. Oh, it s not really no, no, no. It s not really that bad. It s just a little thing. We start explaining it s not your fault. Oh, no, no. It s not my fault. Your doctor prescribed that. It wasn t me. And then we start telling them why it isn t a problem or telling them why you can t do anything, or worse the worst one of all is telling them, Just calm down. These are things that try to make them feel different. Allow them to be where they are. It s okay. Now step number three is emphasize and acknowledge. It s frustrating that you have to wait because your appointment time has been delayed. I m sorry. It s okay to acknowledge their emotions. It s okay to be empathetic. Now of course, we don t want to be sympathetic to where we jump in the boat, Oh, I know how horrible it is. You raced all over town, and you got here, and then you had to wait 20 minutes. Oh, it s so terrible. Sympathetics jump in the boat with them. Empathetic is watching them row to the shore by themselves, Page 7

32 acknowledging that they re rowing by themselves. So empathetic, we re going to acknowledge what s happening. I know it s frustrating when you get here and there s a discrepancy in your appointments. I m sorry for that. That s it. And keep in mind, you don t have to agree with their emotion. Just agree that it s okay to be frustrated. Your goal is to make sure that they understand that you see and hear their emotions. And again, empathy is just reflecting their emotions. I see that, or, It s frustrating, or, I know it s got to be upsetting when... People tend to escalate things when they don t feel heard. Remember that. People tend to escalate things when they don t feel heard. And one of the best ways to help them feel heard is to empathize and acknowledge what they re going through. Now in step number four, you want to find out what they really want. And this is where if their emotional level is low, ask them. Tell me what our looking for. Well you know, I m tired of waiting 20, 30, 40 minutes. I wish when I could come in, I could get right in. And that might be reasonable; it might be unreasonable. But once you know what they really want, it s easier to solve the problem. Now I will tell you sometimes when you do steps one through three, you may have already given them what they need. They may have just needed to know that somebody cared. And sometimes in step number four, what they really want, you can t give them. So you might have to find out what else you could do to make it up for them, or how else you could make it right for them. You know, Mrs. Jones, we can t provide that. But what else could we do to Page 8