By Marc Milano, MD, FACEP 
Topic: Patient Satisfaction
As emergency physicians, we find each day different from the last. We are constantly faced with new patients, new illnesses and new challenges.
But regardless of the day, our focus always is on providing the best care for the patient. And while situations inevitably arise in which patients and their family or friends can become aggressive and outwardly frustrated, there are tips to remaining calm, alleviating frustrations and improving patient satisfaction.
Treat Everyone in the Room
In the emergency department, patients are often accompanied by friends and family members. This is especially true with the very young and the elderly. They need support during times of stress and uncertainty. You can use this fact to your advantage if you follow some simple guidelines.
- When you enter the room, introduce yourself to the patient, then to their family members and friends.
- Find out how the guests are related to the patient.
- Address both the patient and the guests but keep your primary focus on the patient.
- Don’t show that you are frustrated by questions from the group. Simply let them know that you will answer them when you are done evaluating the patient.
- Show empathy toward caregivers and acknowledge their hard work in caring for a sick loved one.
When you’re done with the evaluation, explain your plan, how long you expect the visit to take (OVERESTIMATE!), and then ask the group if they understand. Doctors sometimes are afraid to ask “Do you have any questions,” as it might open the flood gates. However, I’m frequently shocked that the patient and companions have none. Another way of addressing is to ask the family “Does all of this information make sense to you? I know it can be overwhelming.”
You can then get them involved in the patient’s care plan by asking them to help the patient with things like drinking contrast, using the call bell for help or letting you know right away if something changes with the patient.
When you master these concepts and incorporate them routinely into your practice, you’ll rarely have to do “damage control” with an angry family member.
Keep Calm and Treat the Patient
It’s not uncommon to be confronted with an angry or aggressive patient in the emergency department. This is one of our biggest challenges, but handling it well can result in a good outcome, not to mention that it’s a really rewarding feeling to be able to turn a patient’s frown upside down! Be nice, and show compassion and a strong desire to make things right.
First, do not ignore the elephant in the room. If you know what the problem is, confront it directly. Saying things like “lower your voice” or “calm down” almost never help the situation – and in fact generally inflame it. I use phrases like, “I’m Dr. Milano, and I’m here to help understand the problem and do everything I can to fix it.” Sometimes this alone can turn the tide.
Often the anger is about waiting time, so I will offer something like, “I will do everything in my power to expedite your care, without compromising the quality of it.” You must then be prepared to deliver on that promise; however, as failing them again will just cause a re-escalation. Get on the phone with the lab/radiology, etc., and explain the situation. Let the other staff members know what’s happening and reassure them that you have already calmed the patient, but you need their help the keep things that way.
Occasionally, the anger or frustration is due to an unrealistic expectation (think MRI of the finger on a Saturday at 3 a.m.). This is an opportunity to educate the patient as to why a particular treatment or test is not warranted, and maybe explain how it might be harmful or could waste even more of their valuable time. Explain that you will treat the pain, stabilize the problem and provide appropriate referral and guidance to get the problem solved. I will say things like, “My main goal is to rule out the serious things, treat your pain, and then point you in the right direction.”
The ED is full of challenging medical situations. We are on the front lines of the war against death and disease every day. We occasionally make the seemingly miraculous happen. It seems like that should be enough, but our pledge is to treat the whole patient, the whole situation and always to give our best effort.
Marc A. Milano, MD, FACEP, is chief of the department of emergency medicine at Bayshore Community Hospital in Holmdel, N.J. He serves as physician head coach of the Patient Satisfaction Coaching Program at Emergency Medical Associates, an emergency medicine practice headquartered in Parsippany, N.J. Dr. Milano received his undergraduate degree from Rutgers University, his medical degree from St. George’s University in Grenada, and completed his emergency medicine residency at Newark Beth Israel Medical Center.
