Our panel of experts tackle the challenges that confront you every day. Compiled by Kaye McIntosh

Daniel Vincent

Most patients who appear rude are actually frustrated. The single biggest thing you can do is invest in customer service and conflict resolution training, so your staff feel confident in handling difficult situations.

We often try to help by providing patients with more and more information about why we couldn’t do what they want. Yet they can become even angrier. This is where Dr Dan Siegel’s Hand Model of the Brain is useful.

 Dr Siegel proposes that when we are in a stressful situation our ‘lid flips’. Thoughts are routed through the limbic regions of our brain, our ‘dinosaur brain’. We are incapable of processing complex thoughts and instead rely upon our flight or fight response.

When we provide angry patients with more information, it doesn’t help because the brain can’t process it. It simply wants to know that it is safe. There is also a danger that our own lids can flip in response. This doesn’t always mean loud and angry – when my lid flips, I become even more stubborn than normal!

Start to bring someone’s lid down by truly hearing them. Let them speak and provide reassuring noises and words such as ‘I see ‘,  ‘I hear that’. Take notes and nod (even on the phone, it will come over in your voice). A pause is an indicator that they might be finished and starting to settle. Ask if it is ok to go over what they have said so that you can check that you have understood their concern. Use the notes – their exact words where you can – and statements such as ‘you told me…’. 

Acknowledge emotion (eg, ‘you sounded frustrated when’). Knowing that you have heard and understood their concern should bring the temperature down. Next, ask permission to help: ‘I hope that I have understood your concern, can I make a few suggestions about how we could resolve this?’

If you get a no, then return to the beginning: ‘I’m really sorry, tell me a little more so I can understand what has happened’. Hopefully you’ll get a yes and can start to agree a plan to meet their needs.

Daniel Vincent is managing partner at Ryalls Park Medical Centre, Yeovil, Somerset

Steve Williams

Your practice will have a zero-tolerance policy but the ideal situation is prevention. You need to understand your patient. This is also important for patient retention and growth – key to the success of a modern practice.

Before you do this, you need to identify the type of patient that you are dealing with.  Doing this at the outset will save you significant time and energy, which you need to diffuse the situation.

The most common type will be the angry patient.  They just want to be heard.  You can apologise without admitting any fault. Then there is the internet savvy with self-diagnosis.  Again, listening is vital before you can direct them to reputable online resources.

Lastly is the anxious patient.  They might get angry with staff because of this anxiety.  Understand this early and offer sympathy quickly.

In each case, a slight pause, a deep breath and then some reassuring words will help.  ‘I understand that you are upset about xxx.  I am sorry about that but what can I do to help you?’

Then you can find out the cause of the problem and identify what needs to be done.

Steve Williams is co-chair of the Practice Management Network

Nick Nurden

Sadly in the current environment, when supply is simply unable to meet demand it is inevitable that patients will take their frustration out on staff. Ever increasing (and often unrealistic) expectations are created by the media and the government, so at times what we are being asked to deliver by patients is not affordable or possible.

Most practices will take all the usual steps to minimise the risk of patients being rude – notices on the practice website and in the reception area, clear messages about zero tolerance in the patient leaflet etc. but sadly these are all too often not heeded or remembered.

The key to minimising the number of these incidents can be in the way our staff speak to and respond to patients. It can inflame the situation – our response can be a natural reaction to persistent and rude patients, but it is harder for a patient to maintain anger if we remain calm and disarming. This is not easy, especially when the patient is persistent, but it is important for us to support and train our staff so that they are always able to take this approach.

The other important step is to indicate early on that such an approach is not acceptable – as soon as the patient starts to work up towards being rude. Be clear but also try and bring the temperature back down. This won’t always work but it can make a big difference in many situations. It is essential that we have the right culture in our organisations to support our staff when patients are rude, as many will find it very upsetting.

Nick Nurden is Business Manager at The Ridge practice, Bradford, West Yorkshire