The Angry Patient

Angry, obnoxious, or hostile patients are common. Some make demeaning comments or are sarcastic, whereas others are demanding, aggressive, and blatantly hostile. Some hostile patients may remain silent during most of the interview. At other times, they may make inappropriate remarks that are condescending to the novice or even to the experienced clinician. The interviewer may feel resentment, anger, threatened authority, impatience, or frustration. Reciprocal hostility should be avoided, for a power struggle can develop.

The interviewer must realize that these reactions are the patient's responses to illness and not necessarily a response to the interviewer. These reactions may be deeply rooted in the patient's past. Every interviewer should be aware that the same emotions, such as rage, envy, or fear, are present in both the patient and the interviewer. A patient may express feelings toward the interviewer, who must act in a detached, professional way and should not feel offended or become defensive.

Students of the health-care professions may have been taught that they must like their patients to treat them appropriately. Ambivalence in the interviewer can be a problem. Health-care providers must treat patients medically correctly and with respect, but in fact it is not necessary to like the patient in order to provide good care. Because of their illness, patients may have feelings of loss of control, threatened authority, and fear. Their anger is the mechanism by which they attempt to handle their fears. Once interviewers gain this insight and become aware of their own feelings, they can better treat such patients. Interviewers must accept and restrain their own negative feelings toward the patients so that their professional judgment is not distorted. Interviewers' awareness of their own anxieties and feelings aids in conducting a more productive interview. Conscious expression of the interviewer's own feelings in a frank and noninsulting manner facilitates the interviewing process. Regulation and control of the interviewer's feelings is the goal.

Confrontation may be a useful technique for interviewing such patients. By saying, ''You sound very angry,'' the interviewer allows patients to vent some of their fears. Another confrontational approach is to say, ''You're obviously angry about something. Tell me what you think is wrong.'' Maintain equanimity and avoid becoming defensive. If at the beginning of the interview the patient is angry, try to calm the patient. Proceed slowly with questioning, avoid interpretations, and ask questions that are confined to the history of the present illness.

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