Documenting Angry Patients

I’m not really sure what happened this week, but I had two patients whose sole purpose in coming to clinic, was to yell at us. The first patient “fired” us. Patients can fire providers, meaning that they no longer want to receive treatment by that provider. Providers can also fire patients, usually if a patient is non-compliant with treatment or has poor behavior resulting in their expulsion from clinic (violence, harassment, etc.).

Regardless of the reason for firing, the visit must be documented, especially if the patient is refusing further care. This is also true with patients who are suing providers or have additional complaints. Medical records and documents are all accessible by patients and other providers. This means that abrasive, offensive, irritating, or angry conversations must be documented with care.

1) Know When to Quote

Directly quoting patients is a common practice when using the patient’s own words to describe symptoms. When patients describe their palpitations as “fluttering” “sputtering” or in other layman’s terms, I use quotations. When I patient is angry or frustrated, it may be best to avoid quoting. Documenting threats is a must. Expletives and curse words might be better to document as a reference; for example, “patient became verbally abusive, shouting expletives,” as opposed to, “patient said, “**** you you stupid *****!”. Quoting angry phrases may best be re-phrased in more neutral language. My patient said, “You will never touch me again,” but I documented “Patient refused further care.”

2) Document the Reasoning

It is not appropriate to simply document that a patient was angry.  Why was the patient angry? Is it a reasonable complaint? My providers like to be aware of smaller issues to prevent them from occurring in the future. If it is an unreasonable complaint, the provider may review the note if contacted by the same patient.

3) Physical Violence

Physical violence may be more difficult to document. You should never compromise your own safety, just to document what is happening. Fortunately, I’ve never had to worry about this, but I advise documenting as soon as possible (once you are safe, of course). Your memory is more accurate immediately following the incident. Use a voice recording if needed.

4) Use Neutral Phrasing

Medical terminology has several phrases designed to avoid offense, not only for describing physical aspects of a patient but also their emotional state. “Non-compliant” is better than saying “stubborn” or “rude.” Use neutral, accepted language to describe patients whenever possible. You’ll avoid aggravating patients further.

5) Take a Breath

The most important factor is the physician’s frustration. It may be wise to document, then take a break. Step away from the situation, calm down, then return to the note. Read back through your note. Is the note insulting to the patient? Are you heavily biased? Avoid belittling or insulting the patient in their own record. Try to address the cause for misunderstanding in your note while avoiding placing any blame. Sometimes you can explain something 20 times, but the other person won’t understand. It is common sense not to imply a patient’s lack of intelligence, though if you’re caught up in a moment of anger it may be implied.

Do you have any tips on how to handle angry patients?

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