What To Say To An Angry Patient: "I Am Not Your Enemy"

What do you do when you walk into a room and family members start yelling at you?  What do you say to an angry patient or family member?  I say, "I am not your enemy."  I know that the family cares deeply for the health and safety of their loved one. A loved one they feel nobody is looking out for. Someone they feel is being ignored. Someone they feel is suffering at the hands of a dysfunctional system where communication is non existent.

I recently had an encounter with a patient's family, transferred from the nursing home with acute exacerbation of a chronic medical condition. As soon as I walked in, I saw close to ten family members standing there ready to pounce on anyone with anything to say. I could tell, based on nothing more than the looks in their faces that this was going to be

one of those times.

One of those times where family is ready to unleash a tidal wave of anger onto the physician that just happens to show up to do their job. That physician just happened to be me. One thing I have learned in the last six years as a hospitalist is not to take anything personal. But also, not to accept verbal abuse as being OK out of frustration. I have no more a right to yell at family as they do to me, no matter how frustrated they are. I will not allow myself to be abused by a patient or a family. For any reason.

The whole idea of respect for the medical community left long ago when patients and families began their quest for irrational patient expectations. When patients and physicians a like became hired hands of third party systems where the delivery of medical care became nothing more than a a service that needed to be managed.

I cannot imagine for a moment that a physician would be treated with such disrespect thirty or forty years ago. I'm not even certain if the cultural acceptance toward verbally assaulting physicians is an entitlement for just Americans or if the experience is one of world wide acceptance.

We live in a performance driven world based on money. And the current reality is one of volume over time. Where a medication exists for everything. And a lack of improvement is taken as a physician's ignorance and not as a natural progression of the disease/aging process.

So what do I do when a family or patient starts to assault me with their words? I tell them simply

"I am not your enemy. Yelling at me will not make me do anything for you that I am not already doing."

I find that this will often difuse the situation quickly and redirect the anger to someone other than I.  If they continue to yell, I remind them over and over again that I am not their enemy. And before long I generally I have a room full of people apologizing to me for their rude behavior.

It works.  Every time.