09/22/2014 06:12 pm ET Updated Nov 22, 2014

Prescription for the Angry Patient: Communication

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Anger is the human response to unmet needs or expectations. When patients enter a hospital, they expect good care and good communication, and they usually expect to leave the hospital in better shape than they were in when admitted. Unfortunately, any deviance in meeting needs or expectations can result in anger. To complicate things, health care providers typically add to this anger by failing to communicate with the patient regarding why expectations were not met. Providers literally throw fuel on the fire by failing to communicate.

This failure can prompt a patient or family to become so angry they consider litigation. They think a lawsuit will make the providers and hospital listen to them. In many cases, they are right. According to researchers Huntington and Kuhn (2003) the four predominant reasons patients are prompted to file a lawsuit are as follows:

1. A desire to prevent a similar (bad) incident from happening again
2. A need for an explanation as to how and why an injury happened
3. A desire for financial compensation to make up for actual losses, pain, and suffering or to provide future care for the injured patient
4. A desire to hold doctors accountable for their actions

Good communication is the foundation of the physician-patient relationship. In addition to yielding better patient outcomes, good communication between a patient and physician has other benefits. Research has shown that patients are less likely to sue physicians they like and trust. Even when a patient has experienced injury as a result of a medical error, the patient is more apt to forgive a physician or the system if the patient and other party have a trusting relationship.

Angry patients can be lawsuits waiting to happen, yet much of their anger can be diffused through communication with their provider, not a lawyer. Patients want to be heard and want their feelings validated. Patients want someone to be accountable for what did or didn't happen. Too many times, no one steps forward. Despite numerous edicts from various agencies (such as the Joint Commission and Institute for Healthcare Improvement), which advocate for full disclosure from hospitals and providers in the case of medical errors, full disclosure has not been fully embraced. Typically, a patient's or family's anger is directed at the physician because he or she is the most convenient and visible target.

One of the worst mistakes a physician can make when dealing with angry patients or families is to avoid them. Although avoidance is an understandable reaction, it is also the surest way to hasten the patient's visit to an attorney's office. As difficult and unpleasant as it may be, the most effective way to defuse anger is to listen, empathize, and apologize for things that did not turn out the way the patient expected or hoped. Nothing defuses patient anger better than an empathetic health care provider who is willing to acknowledge and discuss the shortcomings of health care, admitting that health care processes and providers need to improve. Studies have shown that, following an error, what patients want from their physicians is an apology and the assurance that what happened to them will not happen to someone else. Patients are more likely to sue when they believe there is a coverup of information or when they want more information and the only way they can get it is to file a lawsuit. Litigation seems to be triggered by uncertainty about what happened and how, as well as by unmet expectations.

The degree of success, whether a doctor or a hospital (or any business), isn't always measured by good outcomes. It is measured by what happens after a mistake. We all make mistakes because we're human; it's unavoidable. What is in our control, however, is the way we treat a person and family afterward.

Dr. Ruth Tarantine serves as the Chair of Online Nursing Graduate Programs and nursing faculty at a private university. With 25 years of nursing experience, she holds a master's degree in nursing from the University of Pittsburgh, and a doctorate of nursing practice from Chatham University. Tarantine is also co-owner of Eldercare Navigators, where she assists seniors and chronically ill individuals with navigating the healthcare system.

As a way to help patients and their loved ones navigate the U.S. healthcare system, Ruth Tarantine DNP, RN wrote the book, Against All Odds: How to Move from Provider-Centered Care to Patient-Centered Care (Amazon, Kindle, and Barnes & Noble online). In her new book, Tarantine chronicles her own struggles and challenges with the U.S. health system during her quest to provide her elderly mother with an acceptable standard of care. Connect with Tarantine on: or Facebook or Twitter.