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Upset Patient Protocol

Rob Orman, MD and Dike Drummond, MD
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We’re not trained in conflict resolution, but angry patients are a reality in any practice. Listening and empathy can go a long way in this situation.

 The Upset Patient Protocol

Rob Orman MD and Dike Drummond, MD 

 Highlights 

  • The Upset Patient Protocol is a way of structuring a conversation with an upset patient 
  • The Upset Patient Protocol is divided into three steps. 

a. The first step is recognizing that the patient is upset and acknowledging their frustration.

b. The second step is asking the patient to tell you about it. 

c. The third step is asking the patient what he/she would like you to do about it? 

* Note: The caveat to the last step is that the health care professional must know the bounds of his/her ability to remedy the situation 

Dr. Drummond recommends that everyone in a practice, from receptionists, to medical assistants, to nurses, to physicians be trained in the Upset Patient Protocol. 

 Background

Dealing with an upset patient can be very stressful and overwhelming for a health care provider. A negative encounter with an upset patient can ruin your day, ruin your staff’s day, as well as disrupt workflow and productivity. The Universal Patient Protocol is a protocol developed by Dr. Dike Drummond to guide the conversation between a health care provider and an angry patient. Dr. Drummond estimates his protocol works about 85% of the time. The below interview discusses the protocol and how to best implement it for the 85% of upset patients who are amenable to discussions of the source of their upset. 

How do you start to defuse the situation with an upset patient? 

  • The first thing to do is to make sure that you yourself are centered and have the presence of mind to notice when somebody is upset.

What are the steps to the Universal Patient Protocol? 

  • The first step after centering yourself and then to start by saying “You seem upset.” 
  • The second step is inviting the patient to tell you about it. The reason this step is important is that the patient may not offer the source of their upset unless you give permission to do so. The start of the conversation would then be. “You seem upset. Tell me about it.” 
  • After sincerely apologizing for the way that they feel, the third step involves asking the patient what he/she would like you to do about it. Asking this allows the provider to understand the patient’s agenda. 
    • You should realize that you do not need to do what they are asking in every instance and you can establish boundaries around the relationship. 
    • Often, however, the requests are simple, reasonable and within your power to do. 
What are the common pitfalls in carrying out the Universal Patient Protocol? 
  • During the course of the conversation, do not fall into the temptation to defend yourself. Dr. Drummond suggests that you breathe and remember, “They don’t care how much you know until they know how much you care.” 
    • Example of scripting: “Wow. That sounds really frustrating. I’m so sorry that happened to you.” 
  • No protocol works universally. Dr. Drummond estimates about 15% of patients will not be amenable to the boundaries established when using the Universal Patient Protocol. 
  • If you feel as though you are in danger, you should walk out of the room and if need be, call for help. 
  • Rehearse important conversations before an encounter Dr. Drummond recommends practicing with the training materials found on his website. Everyone in the office has the ability to use these techniques 
  • Conclude the Upset Patient Protocol. You may say “Thanks for telling me about this. It is obviously really important. Is there anything else you want to do or say about this today?” Then, you can move on to the medical portion of the visit. 

Note: This protocol is based on the premise that most of the time the upset of the patient stems from non-medical errors. If a patient is upset secondary to a medical error, a different protocol should be followed. 

Reference: 

http://www.thehappymd.com/blog/bid/290399/Doctor-Patient-Communication-The-Universal-Upset-Patient-Protocol 

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Teeth, FUO, and Upset patients Full episode audio for MD edition 189:34 min - 220 MB - M4AUrgentCare:RAP 2015 July Summary 732 KB - PDF