Rebekah Bernard, MD, provides tips for improving interactions with patients who are angry.
Here’s an all-too-familiar scenario: You walk into the exam room to find your next patient glaring at you, arms crossed, lips pressed together, clearly angry.
“It’s about time!” the patient seethes as you settle into your chair and start to open the computer chart.
Your chest clenches. You are running late, it’s true, but it’s because you just spent an extra 30 minutes with your last patient helping her through a new diagnosis of cancer.
You try to hold back your emotions and get the visit on track. “I’m very sorry to keep you waiting, Mr. Jones. How can I help you today?”
But Mr. Jones isn’t ready to move on. He is still furious at being kept waiting. “Do you think that your time is more important than mine?”
Warning bells go off. Your fight-or-flight emotions are triggered, and if it’s a particularly bad day, you may explode at Mr. Jones and say something you’ll later regret. Or you may force yourself to swallow your feelings of anger and frustration, where they will slowly eat away at you, leading to anxiety and depression. Either way, Mr. Jones isn’t going to be happy, and neither are you.
But you can change this outcome by the simple technique of emotional mirroring and validation.
One of the problems with strong emotions is that they are controlled by the primitive, mammalian brain, which is responsible for core emotions and our fight-or-flight response, rather than our more advanced neocortex, or “human” brain. When we experience a strong emotion, such as anger, sadness, or fear, the mammalian brain becomes active and takes over the human brain. It then supersedes our higher order brain functions of empathy and advanced thinking.
While experiencing powerful emotions, our amygdala becomes overstimulated, locking us into our primitive brain and preventing us from accessing our higher order brain function. Daniel Goleman, in his book Emotional Intelligence (1995), termed this state “amygdala hijacking.”
Amygdala hijacking explains why someone in a strong emotional state may respond poorly to directions, commands, or suggestions. For example, if you ask an angry person to “stop yelling,” they may shout back at you, “I’m not yelling!”
The key to overcoming amygdala hijacking is using the technique of emotional mirroring and validation.
Emotional mirroring can be as simple as repeating back and validating the patient’s emotional state. The first step is to identify the emotional state based on what the patient is saying, and by the nonverbal cues that the patient is showing, such as facial expressions, gestures, and mannerisms.
In the case of Mr. Jones, you identify his emotional state as anger—he is glaring, his arms are crossed, he is jiggling his foot, and he is breathing rapidly.
Once you have determined the emotional state, practice emotional mirroring by simply stating to the patient how you believe he is feeling.
Doctor: “You seem angry.”
Now, ask if you are correct.
“Is that right?”
If you are correct, continue to mirror the patient’s emotions.
Mr. Jones: “Heck yes, I’m angry! I’ve been waiting for you for an hour!”
Doctor, mirroring, and with empathy: “Wow, you’ve been waiting for an hour.”
Next, validate the patient’s emotion. This doesn’t mean you are saying that the patient is right, and it doesn’t mean that you agree with them. You are simply acknowledging that you understand their emotional state.
Doctor, validating: “I’ll bet I would be feeling angry and frustrated if I waited in a doctor’s office for an hour.” When validating, be sure to show empathy through the tone of your voice, facial expressions, and by using eye contact.
When practicing emotional mirroring, be sure to ask if you are correct. If so, proceed with validation. However, if you are not correct, you will need help to identify their emotional state. Do this by asking the patient how they are feeling, and then proceed to mirror the emotional state they identify.
Mr Jones: “No, I’m not angry.”
Doctor: (in a genuine and compassionate tone—being genuine is vital to the success of this technique) “Oh, then, how are you feeling?”
Mr. Jones: “I’m worried!”
Doctor, mirroring: “Oh! You’re worried?”
Patient: “Yes, I’m worried about my test results. I’ve been sitting here for an hour thinking that you’re going to tell me that I’m going to die.”
Doctor, mirroring and validating: “You’ve been sitting here waiting for an hour worrying about your results. I can see how stressful that must be for you to have to wait so long. I bet you’re feeling pretty annoyed with me right now.”
Believe it or not, at this point the patient will likely deescalate and ally to you saying something like, “No, I know you are busy; you’re a good doctor and that’s why I want to see you over someone else, so I don’t mind waiting.”
If not, continue to allow the patient to talk, practicing emotional mirroring and validation until the patient gives an audible sigh. This sigh is a common phenomenon signaling that a transition has occurred from the mammal brain to the human brain, and the patient is ready to move forward.
Whatever you do, do not try to address the person’s problem until they invite you to offer feedback, saying something like, “So, what do you think?” or, “Well, are you going to tell me about my results?” Once the patient makes this type of statement, it means that they are no longer stuck in an emotional state and are beginning to use higher order thinking, where problem solving occurs.
Remember, the process of mirroring and validation is not telling the patient that they are right or that you agree with them. It is simply a tool that allows you to show the patient that you understand his or her emotional state and belief set at that moment.
So, the next time you experience a patient in a strong emotional state, follow these steps: 1) Identify the emotional state. 2) Emotionally mirror by simply stating how you think the patient feels. 3) Ask if you are right. 4) If so, validate how the patient and show empathy. You will be amazed at how well this technique defuses even the most stressful situation.
Rebekah Bernard, M.D. is a family physician and author of Physician Wellness: The Rock Star Doctor’s Guide. Change Your Thinking, Improve Your Life.
This article first appeared on our sister site Medical Economics.