What To Do When Your Patient is a Bully

[rEliseMe]

Since this topic hasn't been discussed here on SDN, I figured I'd open it!



Anyone ever had a client who was rude, confrontational, or just plain mean?

How did you deal with, it in the moment and after the fact?

Did you have to see them more than once? If so, how did you keep yourself from taking the bait and/or sobbing during the appointment?

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[jlambarty]

Since this topic hasn't been discussed here on SDN, I figured I'd open it!



Anyone ever had a client who was rude, confrontational, or just plain mean?

How did you deal with, it in the moment and after the fact?

Did you have to see them more than once? If so, how did you keep yourself from taking the bait and/or sobbing during the appointment?

(a) Slap him/her
(b) Show your sexy side
(c) Promise a McDonald meal?

 

[BigAl]

Since this topic hasn't been discussed here on SDN,
Anyone ever had a client who was rude, confrontational, or just plain mean?

How did you deal with, it in the moment and after the fact?

Did you have to see them more than once? If so, how did you keep yourself from taking the bait and/or sobbing during the appointment?

There will always be one to ruin the entire day for you and the staff.
It's really simple to deal with these folks, kill them with kindness.
You can also give them alcohol swabs to clean up their face after an ENG

 

[EitherWise]

Since this topic hasn't been discussed here on SDN, I figured I'd open it!



Anyone ever had a client who was rude, confrontational, or just plain mean?

How did you deal with, it in the moment and after the fact?

Did you have to see them more than once? If so, how did you keep yourself from taking the bait and/or sobbing during the appointment?

oooh good question and definitely one that comes up a lot. I feel like this can be a situation you never feel comfortable with until you look back and realize you have been seeing patients for X number of years and you are fed up with taking "crap" from patients.

I agree with big al in "killing them with kindness" but you also want to do your best to control the appointment. I feel like this is one of things that differentiate those supervisors who are better than just good but great. If a patient is giving you a hard time, say very plainly "that you want to help but progress cannot be made until the patient is willing to see you as an equal in this professional relationship" (or something close to it, make it your own). I think it would also bee a good idea to chart note about the appointment - list out some of the issues so you can create some accountability for that patient and whomever he/she sees next. If the patient is still acting the same way at the next appointment, then clearly the patient is still not ready to be helped.

 

[Kitska]

I think some people are just grumpy by personality. Others might be angry with their hearing loss and taking it out on you, or they may have just had a bad day.

I will never forget the really mean lady (the wife of a patient -- total b__ch!) who I tried the kill-them-with-kindness technique on. I complimented her on her clothing. It truly was beautiful satin in a deep red color. But I think I made the mistake of calling it a "coat." Instead of thanking me or telling me where she got it or any of a number of things any normal person would have said, she said in the most snotty voice possible, "It's a jacket!" Sometimes you just can't win and you just have to shrug it off or laugh about it later.

 

[KCO47]

Gosh I have one of these, and I feel like I'm in a tight spot. The guy makes me so uncomfortable and "killing him with kindness" looks like my only option. But he just won't die.

My preceptor works on commission and isn't willing to put him in his place... and as the student, I don't feel like I can either.

 

[DrAudio]

Excellent question! Also good to see you're moving forward in your career because this happens OFTEN. Although somehow never happened to me when I was actually a student.

You have to remember that your patients are paying your bills. Especially with the BS insurance system we have to deal with at the moment. But that said, you CAN and SHOULD be firm with them. You are providing a service to them and are there to help them, not get beat up by them.

"My job is to help you hear better; but if we cannot communicate effectively, I can't do my job." - this tends to soften them up a bit and can be used in virtually any situation. Communication is a two way street and sometimes people just push to find the limits and from there on out things are easy.

"You can treat me in any manner that you want because I can handle my own. But I will not tolerate you harassing my staff in ANY manner. Consider this your only warning." I don't like threatening patients but one thing I will not tolerate is harassment. Ladies you'll get a lot of leering old men if you haven't already and somehow they think it's ok to make comments - and oddly enough even try for some grabs. That is the only thing that will get me to give a patient a boot to their saggy behind. I mean, geez, there are certain things you can't even get away with at a bar when you're drunk what makes you think you can do it in my clinic!?!

What specifically are you referring to or has happened? Was your preceptor there and how did they handle it?

-D

 

[rEliseMe]

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[Dustbug10]

I definitely look to establish dominance from the onset of the appointment. You definitely need some sort of accessory that screams "alpha-male". I personally carry a crowbar.

 

[trekaud]

I think killing a person with kindness isn't always the best strategy. In some situations it definitely is but most of the time if a patient comes in with an attitude or are getting up on a high horse I take my niceness and small chit chat out of the equation. I'll be a bit brusque but remain utterly professional. Sometimes they're looking for a scapegoat to throw their problems on but sometimes they are just looking for a straight laced no nonsense clinician. It may be hard for someone in their 70's to respect a young chatty girl in her 20s on a professional level. Either way if a patient is being difficult I don't try to win their approval, I just power through and finish up the appointment.

 

[rEliseMe]

I know what you're saying about the respect issue. I'd say probably most of my clients respect me because I haven't given them any ammunition not to, but I'm sure there are some who think I couldn't possibly be respectable enough at 22. Thankfully, I don't feel like I have to prove that to them, as long as I provide top-notch patient care. That's certainly something I wish I was warned about, though.

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[TheEarDoc]

If you are fortunate (or maybe unfortunate) enough to work in a large hospital, you will deal with a lot of Medicaid patients. Now I'm not trying to start a flame war or any nonsense like that, but many of the folks in the area I first started practicing in were very much entrenched in the entitlement culture. Many were 3rd or 4th generation that had had Medicaid as their insurance and many felt entitled to everything a private party insured working individual would get. Many hated the red tape for getting appointments or hearing aids or tests approved by Medicaid (I hated this too as a practitioner). So it was a perfect recipe for patients to be angry and take it out on you.

What you always have to keep in mind even as a student is, you are the expert. You will know more than the patient. If you did not then you wouldn't be sitting on the opposite side of the table. Kill em with kindness usually works, but some people you have to realize will not be happy no matter what you do. How will you know? It will just take experience. Being male it is easier to get respect by most patients. It's very sad, but it's true. So I have no trouble being gruff when I need to be. I also think having experience working in nursing has helped me know when to turn the switch so to speak and be gruff.

Just remember never make threats with an unruly patients. You can't back up threats. You must present instead consequences. I've flat out told patients before that if they did not fix their attitude that I would no longer see them and did not have to see them if I felt they were a threat to me or other staff. This usually calmed most down because they realized that I would not take crap from them.

The other thing to remember is often times by the time a patient gets in your office or booth they've been through a lot of other places and red tape and are quite frustrated. Several patients I saw had reported their hearing problems to several physicians and never got referred or just sat for 4 hours to see the ENT before being sent up to see me. It happens. I usually try defusing the situation first by saying something along the lines of "I can see you seem upset. Tell me what is going on and what you would like me to do to help."

This usually takes them off the defensive and I give them about 5 minutes to vent. Then I explain what I can do, what I can't do, and more importantly I tell them what I will do and then I follow through with it. Often most places have a patient advocate you can deflect to if the situation feels out of your control.

The important thing is remain calm. If you appear rattled then the patient will own you. Stay calm and in control and the patient will know that you are running the show.

I recommend all students taking a confrontation management or conflict resolution course online. If you are in the VA system you can do these trainings online and for free.

 

[Shnurek]

Being male it is easier to get respect by most patients. It's very sad, but it's true. So I have no trouble being gruff when I need to be. I also think having experience working in nursing has helped me know when to turn the switch so to speak and be gruff.

This is true. As much as we like to believe we live in a politically correct society people will always have their prejudices. I can second this because there were numerous occasions in my school where the patient asked for a "male intern" and if they didn't get one they just left the clinic.

 

[Dustbug10]

Being male it is easier to get respect by most patients. It's very sad, but it's true. So I have no trouble being gruff when I need to be. I also think having experience working in nursing has helped me know when to turn the switch so to speak and be gruff.

I won't deny this, though in my case it doesn't always apply. Because I seem to appear younger than my age, patients often enter the session not taking me all that seriously. Some have even assumed I was a high school student job shadowing. By the end of the session, things are much much better. It has taken a ton of practice to get to that point.

The important thing is remain calm. If you appear rattled then the patient will own you. Stay calm and in control and the patient will know that you are running the show.

This . Appearance can put you at an immediate disadvantage at the start of the session, whether you're a female or a male with a baby face. Learning to direct with real confidence every step of the way overcomes it. Sometimes, patients will bully regardless of your gender or appearance. A few weeks back, a patient screamed at my 6-4 preceptor, "I wouldn't turn your back on me if I were you!".

I recommend all students taking a confrontation management or conflict resolution course online. If you are in the VA system you can do these trainings online and for free.

I took mine Monday. The staggered stance is key.

 

[AuD23]

A few weeks back, a patient screamed at my 6-4 preceptor, "I wouldn't turn your back on me if I were you!".

I'm not in grad school yet so maybe I'm naive, but I do have a good amount of observation hours under my belt and it just blows my mind to read things like this. Sure, In my observations there was a very occasional clash of personalities, but nothing serious at all. Both parties just knew not to expect an invitation to the others family Christmas, and that they wouldn't be having drinks together after work anytime soon. No big deal. What on earth can put someone so over the edge at an audiology appointment? Really, I need help understanding so I can prepare myself for future situations...

 

[rEliseMe]

What on earth can put someone so over the edge at an audiology appointment? Really, I need help understanding so I can prepare myself for future situations...

Just from the top of my mind: being kept waiting, seeing a different clinician than they expected, seeing a clinician who doesn't know every detail in their chart, etc.

Or they could just be having a bad day already and need someone to take it out on.


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[Dustbug10]

I'm not in grad school yet so maybe I'm naive, but I do have a good amount of observation hours under my belt and it just blows my mind to read things like this. Sure, In my observations there was a very occasional clash of personalities, but nothing serious at all. Both parties just knew not to expect an invitation to the others family Christmas, and that they wouldn't be having drinks together after work anytime soon. No big deal. What on earth can put someone so over the edge at an audiology appointment? Really, I need help understanding so I can prepare myself for future situations...

Honestly, I've rarely encountered such instances, but it does happen. Some patients are just angry at the world and people who are forced to be nice to them are easy targets. The incident I referred to involved a a military veteran with severe PTSD and Narcissistic Personality disorder. All patient incidents that I've witnessed have occurred in this setting, but rest assured, they're out there all over the place.

 

[TheEarDoc]

I'm not in grad school yet so maybe I'm naive, but I do have a good amount of observation hours under my belt and it just blows my mind to read things like this. Sure, In my observations there was a very occasional clash of personalities, but nothing serious at all. Both parties just knew not to expect an invitation to the others family Christmas, and that they wouldn't be having drinks together after work anytime soon. No big deal. What on earth can put someone so over the edge at an audiology appointment? Really, I need help understanding so I can prepare myself for future situations...

Well if you work in a large hospital sometimes patients get very frustrated because they get lost finding your office, or they've been waiting for hours in the ENT office before they see you, or they get incorrectly scheduled, received a bill they don't agree with, had a previous bad experience, are angry they have to pay for hearing aids, are angry that you cannot perform a certain test at your facility (ABR, VNG, etc.), or sometimes they just need someone to vent to and you happen to be the one they choose.

I'll agree with Dustbug that the VA often gives you more of a chance of running into this since our veterans have been through a lot, but I've had similar confrontations in hospitals and clinics too. You never know what someone is going through or what will trigger them. With HIPPA policies though you have to keep a door closed so that often times can mean you are in an enclosed space when things go sideways. I remember one time a patient attacked me in the booth and I was the only one working in my side of the office. Always keep the door near you and never allow the patient to be between you and a way out. My office has always been set up on purpose so I am close to the door and do not have to go past the patient to get out if something goes wrong.

This isn't meant to scare you, just prepare you. We work with people and people are unpredictable. I mean there is less chance of issues in our field compared to say nursing or medicine, but we still sometimes see the mentally ill. Sometimes certain patients just give you the willies. You'll know it when you meet one.