This month’s article was provided by The Coker Group, an SMA approved partner.

• The Angry Patient

  By Kay Stanley, Associate Partner

  The Angry Patient--the one who behaves badly and is likely to cause a scene when asked for payment or can’t get what he or she wants. What do you do when a patient becomes uncontrollably angry?

  It’s happening everywhere! The problem is wide spread and can be instigated by a number of factors, typically financial. Health plans with higher deductibles, requirement for collection of copayments, and reduction in coverage is having a significant affect on patient behavior. With the increase in patient responsibility for payment and higher out-of-pocket expenses, medical practices, hospitals, and other providers are encountering the angry patient.

  Practice administrators and those who work in organizations with responsibility for collecting from the patient report an increase in angry patients who are apt to throw fits, refuse to pay, pose threats to safety, and outright lie about their intentions. Medical office buildings staffed with security officers are frequently called to escort the irate patient away, and increasingly police departments have designated officers to handle problematic patients who demonstrate extreme conduct.

  What is anger and how does it affect a person? In an article titled “Anger management FAQ: the good, the bad, the ugly,” Robert T. Zackery writes: “Anger is a feeling of displeasure or hostility. It’s a normal, healthy emotion, just like any other feeling. Anger has several components:

  • Psychological. This is the emotional component of anger, how you feel, such as sadness, disappointment, or frustration.
  • Physiological. This is how your body responds to anger, such as developing muscle tension or an increase in heart rate and blood pressure as your body releases adrenaline.
  • Cognitive. This what you think as you experience anger, such as acknowledging that it’s OK to be frustrated, or, on the other end, thinking that the world is out to get you.

  In essence, anger is a warning bell that tells you something is wrong in a situation. It’s a natural response to perceived threats.” ¹ However, when uncontrolled, anger can result in a dangerous incident.

  Administrators, practice leaders, and front end and back office staff must learn how to deal with the patient whose anger is out of control. There’s usually an activating event that causes anger—something in particular that sets off the rage in a person—such as a disagreement, being stuck in traffic or not being able to get through to an actual person on the phone. Some people may be angry about their own personal circumstances, such as when they are plagued by financial problems. Although the angry patient knows no specific demographic profile, increasingly it is the elderly patient that cannot assimilate the vast changes that have occurred in healthcare delivery and payment policies, with a limited income to boot!

  When financial problems are the underlying cause for stress in the patient who also may not be physically well, the fuse can be extremely short that causes the behavior to “blow.” On the other hand, some people have become accustomed to getting their way by acting out. In either case, situations can get out of control and safety can be a real factor that must be addressed.

  Safety, in fact, is the real issue. You are responsible for providing a safe workplace for your staff. Employees cannot function in a hostile work environment. Likewise, other patients are in danger and imposed upon by episodes of anger. Education and training on how to handle the patient who “snaps” is a fundamental element of safety.

  Following are some pointers to keep in mind in making the most of these meetings.

  • Use a form to conduct an exit interview. This will help you to stay on task and ensure that you get the information that you need to obtain. This can be done by asking questions or by presenting a form to the departing employee.
  • Send payment policies to new patients when appointments are set
  • Make sure that arriving patients understand your expectation for payment
  • Explain your policies clearly, simply, and tactfully, noting that medical practices or organizations, like other businesses, cannot operate without necessary funds
  • Make clear that healthcare plans have contractual requirements for physicians and hospitals, such as collecting copays and deductibles.  You are obligated to honor the patient’s health plan.
  • Stay in control of your own emotions.  Don’t take the anger or accusations personally.  Listen, speak calmly, and do not argue.  Refer to “policy” rather than personality.
  • Develop a plan for handling the out-of-control patient, such as
  • Escort them to a private room
  • Have two people with the patient at all times
  • Designate a person to call security or the police
  • Have a rehearsed “script” for dealing with the patient
  • Hold a debriefing meeting with your staff to review what transpired and what improvements can be made to avoid future events.  Some people will be intimidated or anxious by anger expressed inappropriately.  Be aware of their emotions.
  • Immediately, send a Letter of Termination of Patient Care to be delivered as soon as possible.  This should be certified with a request for notification of delivery, giving notice of when care will end (typically 30 days).

  In conclusion, beware of the angry patient and be prepared. You can expect to have them in your practice. Have a definitive plan of action for dealing with the circumstances and be courageous in sticking to your plan.

  Kay Stanley directs The Coker Group’s education and training initiatives and can be contacted at 678 428 0453 or kaystanley@cokergroup.com.

  1. Zackery, RT, Anger management FAQ: the good, the bad, the ugly – MayoClinic.com, http://www.mayoclinic.com/health/anger-management/MH00075, accessed 10/19/2007.