HealthMarch 16, 2020

Five ways to prepare for difficult patient interactions

By: Julia Michie Bruckner, MD, MPH
If you know a challenge is coming, plan ahead. Here’s how to use mental preparation, teamwork and self-care to prepare for difficult patient interactions.

I gulped down a few swigs of lukewarm coffee, then headed to see my next patient. The charge nurse, her face unusually tense, stopped me.

“This mother may be difficult,” she warned. “She already cursed at the front desk staff and has been pacing ever since we brought her and her son to the room.”

It had been a rough shift in the pediatric emergency department already—the winter brought long wait times, high fevers, hacking coughs and anxious parents. The hours spent calming and apologizing to families had already exhausted me. The thought of more difficult patient interactions was demoralizing.

I didn’t want an already volatile situation to escalate; I knew I had to harness the tools I’d learned over the years, particularly from nurses, social workers and physicians working in high-stress environments like the emergency department and intensive care unit. Here are five tips I’ve found helpful to prepare for difficult patient interactions.

1. Assess yourself first

Your own mental preparation is essential. Pause, take your pulse and reflect on how you feel. Are you anxious, scared, tense, hungry or tired? Entering a heightened patient encounter with these feelings can be exacerbating. Acknowledge your state of mind, then find ways to adjust it. Calm your nervous system with deep breathing. Visualize your favorite relaxing spot. Drink some water or eat a snack.

2. Amp up empathy

Patients deemed “difficult” can feel the most challenging to empathize with, but they often need our empathy the most. As our parents may have taught us, negative interactions can be countered with kindness. Think about yourself on your worst day, and imagine that your patient may be having their worst day. Consider all the stressors they may be facing.

3. Strategize With Others

Talk with your team members who have already interacted with the patient and family. They may have insights into the roots of the difficulty; consider these, but be wary of letting them cement your perception of the patient. Recruit others to come in the room with you to support, witness and share their feedback on your communication. If potential violence is a concern, make security aware of the situation. Define your personal boundaries beforehand.

4. Enter calmly

Recognize that your actions, words and tone of voice can influence the mood of the room, starting with your entrance. From the beginning of the interaction, aim to “Keep Calm and Care On.” Enter with a smile and then sit. Try starting with a calm acknowledgment of their mood. Say something along the lines of: “You seem stressed/angry/sad/frustrated to me—do you mind sharing with me the reasons for your feelings? I’d like to help.” Then listen while you also focus on keeping yourself calm and unprovoked.

5. Find your rituals

As a professional caregiver, you must also care for yourself; otherwise, you won’t be able to give your best to your patients—especially the most challenging ones. Explore ways to help keep yourself calm and restored before, during and after your clinical work, then aim to turn those into ritual habits. Consider ways to integrate them into your work routines, such as doing meditative deep breathing each time you wash your hands.

Rituals I’ve found to work well for me are meditating for a few minutes in my car before and after my shift, keeping a vial of invigorating peppermint oil nearby to smell as I practice deep breathing between patients and listening to soft music as I chart. I also pack a variety of portable high-protein, low-sugar snacks and a huge mug of my favorite tea.

Find support through colleagues, friends, therapists or journaling. The life of a physician carries unusual stressors; we need to find safe and healthy ways to vent and decompress, and we can’t always do it alone.

I leaned on my colleagues in preparation for the difficult mother that day, talking briefly beforehand with the bedside and charge nurse, grabbing bottles of water for myself and the mother, taking a deep breath as I sanitized my hands and entering with a gentle knock. The mother met me with fiery eyes, but soon softened as I apologized for her wait and let her share her distress. She felt others hadn’t taken her child’s symptoms seriously and worried about paying for care as the family’s insurance had just lapsed. Our team was able to address her fears, and the visit ran smoothly. After, I debriefed with the nurses, splashed some cool water on my face, took another deep breath and moved on to the next patient.

Julia Michie Bruckner, MD, MPH