Causes of anger:

 Medical or surgical team errors ❌ 

 Bad news 

 Long waiting times (e.g. before being seen in the clinic or Accident and Emergency department) ⏱ 

 Long delays between diagnosis and treatment ⏱ 

 Unmet expectations

Drugs and alcohol, mental health issues, anger management, and/or violence/aggression can increase the above issues 

Identifying anger: 

It is important to recognise that the patient or relative you are speaking to is angry so that you can respond appropriately  

Behaviour indicative of anger: 

 Shouting or loud speech 🗣

 Verbal abuse (e.g. swearing) 

 Higher pitched voice 

 Clenched fist/shaking 🤜

 Frowning 😞

 Aggressive posture (e.g. not sitting) 

 Being oversensitive 

 Eye contact changes (e.g. suddenly look downwards) 👁

 Walking away (or threatening to do so) 🚶

Remember, some people display anger more subtly (e.g. go quiet, giving one-word answers)  

How to adjust your communication when a patient or relative is angry: 

Voice:  

 Do NOT raise your voice in response to the patient doing so 🗣

 Speak clearly and slowly 

 Stay calm 

Body language: 

 A relaxed but professional posture is important 

 e.g. 2 feet on the ground, arms and legs uncrossed and back against the chair when sitting 

Acknowledgement of anger: 

 Pointing out that they seem angry can be helpful 

 e.g. “you seem to be angry” can help the patient to recognise this and gain composure 

 In return, they may agree or correct you, which enables you to adapt your response 

Understanding their anger: 

 Asking questions: can help you to understand the reason for their anger e.g. frustration/fear ❓ 

 Listening is vital: let them vent if they need to, do not interrupt them, actively listen (nodding, verbally responding, using eye contact etc.) 

Responding to anger: 

After gathering information about the patient’s anger, and allowing them to say what they need to, it is important to respond appropriately

 Empathy: acknowledge their emotions and show that you understand why they are angry 

 Apologise if necessary: apologise if you/the medical team are at fault but do not allow the patient to blame you if not

 Thank patient: thank them for sharing their feelings, if appropriate 

 Encourage solutions: ask the patient or relative how they suggest the situation should be rectified or suggest your own solutions if they are unsure

 Interview closure: thank the patient or relative for their time, suggest the steps of the plan going forward 

What to avoid when dealing with angry patients/relatives: 

 Suggesting a quick solution: instead, allow them to discuss their feelings first ⏳ 

 Getting angry: remain professional, showing your anger may make the patient or relative more angry 😡

 Being defensive: this can escalate the patient or relative’s anger 

Difficult situations:  

 The patient or relative does not sit down despite you asking to: do not focus on this; you may find it most appropriate to remain standing so you are both at the same level 

 You feel threatened: if you are concerned that the anger may turn to violence, you should remove yourself from the situation ➡  

 Your colleague is responsible for the patient or relative’s anger: if the patient or relative blames your colleague, ideally they should apologise themselves, but you should not be overly defensive, nor encourage them 😡 

 The patient or relative remains angry: sometimes it is unreasonable to expect them to ‘calm down’ 😡

 The patient or relative wants to file a complaint: assess their reasons, to see if you can resolve the issue. If they still wish to file a complaint, this is their right and so you must provide them with the information required to do so 

 Whilst ‘venting’, the patient or relative is becoming more angry: carefully interrupting the patient can be useful in this instance, but be sure to apologise for doing so 

Remember your own feelings are important: 

 Be aware of your stress levels 

 Take actions to relax, e.g. speak to a colleague/ take a break 

Summary:

1. Patients can become angry when: errors are made; there are long waiting times or delays; they receive bad news; their expectations are not met
2. You need to be able to identify when a patient or relative is angry
3. You should not raise your voice; you should maintain a relaxed and professional posture; you should acknowledge their anger
4. Asking questions and listening to the patient or relative is important 
5. You should be careful not to make the patient more angry
6. You prioritise your safety