Article from the Boston Globe’s On Call Magazine, October 2005

By Helen Osborne, M.Ed., OTR/L
President of Health Literacy Consulting

When people are anxious or angry, they may not be able to make sense of what you are saying. It can also work in reverse. The intensity of a patient’s or a family member’s feelings can interfere with that person’s ability to put words to his or her most pressing concerns. Strong emotions can make it a major task to comprehend new or complex medical information.

Intense anxiety or anger can get in the way of good treatment and care. For example, a 73-year-old man was scheduled for surgery to confirm a cancer diagnosis. He and his wife arrived on time for early morning surgery. But soon after they arrived, they were told that the surgery was delayed until early afternoon. By mid-afternoon, they were told that — due to many unexpected surgical emergencies — the surgery would be postponed for one day.

Already anxious about his diagnosis and upcoming surgery, the patient and his wife were irate that the surgery was cancelled. The unit staff, nurse manager, and physician all tried to calm the family, keeping them abreast of pertinent information and offering support and reassurance. They also admitted the patient to the hospital so that he would not have to go home that night.

However, the next morning, the wife was even angrier. She seemed to complain about everything, including the temperature of her husband’s hospital room. The unit staff asked the patient advocate to intervene. When the patient advocate met with the wife, she began by asking, “What can I do to help you get through this day?” The wife talked about her frustration with the excessive heat in her husband’s room. The patient advocate calmly and efficiently addressed this concern. When she realized the solution required more than just turning down the thermostat, she asked a maintenance worker to meet with the patient’s wife. The wife calmed down as soon as she heard an explanation of what was wrong, thanking the patient advocate for her assistance. It was only then that she started to share her real fears about her husband’s upcoming surgery.

Helpful Ways to Get Beyond the Feelings

When emotions run high and communication becomes problematic, patient advocates and social workers can help. Linda Burke, RN, is the patient advocate in the Quality Management Department at Milton Hospital in Milton. She serves as a liaison between patients and hospital staff, helping people find solutions to vexing problems and concerns. Fay Crossley LICSW is a clinical social worker in the Care Management Department at the same hospital. As part of her job, Crossley provides support to patients and families, helping them cope with the emotional effects of an illness and hospitalization.

Burke and Crossley offer the following tips to help clinicians communicate more effectively when emotions of their patients run high and anxiety or anger gets in the way of effective communication.

Appreciate how anxiety provoking it is for patients to be in the hospital. Hospitals and healthcare settings are familiar places to health professionals. But to patients and families, especially those who have never been hospitalized before, these settings can be scary places. Even routine events and procedures can be anxiety provoking. Gall bladder surgery, for example, can feel as traumatic as open-heart surgery to many patients and families. Knowing what people feel makes it easier to help them understand what they need to know.

Start with the concerns of the patient and family. In the case of the wife who was  irate about the temperature of her husband’s room, the patient advocate needed to address the wife’s concerns first. If she had insisted on only talking with the wife about her husband’s surgery, the outcome may not have been so positive. Indeed, the wife’s focus on environmental concerns may well have been her way of coping with anxiety over her husband’s illness.

Find a private place to talk. Whenever possible, take the upset patient or family member aside and speak privately about his or her concerns. If it is not possible to go to a separate space, create more privacy by closing curtains, shutting doors, or repositioning chairs.

Give whatever choices you can to the patient. Most decisions in healthcare settings are made for patients and families. They usually have limited control, for example, about when tests are scheduled, what time to eat, or even what to wear. Sometimes what appears to be uncooperative behavior may instead by a patient’s attempt to maintain some control. As often as possible, allow patients and families some choices.

Choose your words carefully. Avoid using judgment phrases. It can minimize a patient’s experience when health professionals say that a procedure has been delayed for “only” a day, or that he or she is “just” having gall bladder surgery. Appreciate also that when people are anxious, they may only comprehend part of what you are saying. Be prepared to repeat information, offering a pad and pencil so that the patient or family member can take notes and jot down questions.

Consider your nonverbal language. Smile and approach patients and families in a calm manner. Help patients relax by speaking audibly, but softly. Attitude can also make a huge difference. As said by one nurse who earns high praise from patients and families, “It isn’t anything magical I do. I’m just nice to patients.”

Listen, and let the patient talk. Don’t argue, even if you know you are right.Listen to what patients or family members have to say — they might calm down simply by being able to share their concerns. Do not insist on meaningful conversation when patients and families are not ready. “People aren’t always ready to talk when you’re there to talk with them,” says Crossley.

Let families know how they can help. Healthcare is a joint effort with patients, families, and health professionals. Be clear and specific about what each person can do to help. Encourage family members to participate as they are able and willing to do so. For example, suggest they might help you phrase medical concepts in ways that the patient will best understand.

Be aware of your own feelings and limitations. Health professionals are not immune to anxiety or anger. When you find yourself in an upsetting situation or are having a bad day, talk with your colleagues or supervisor. Let others help you problem-solve ways to improve communication. “Know your limits” says Burke. “Not everyone can care for every type of patient.”

How To Find Out More

Linda Burke, RN, Patient Advocate in the Quality Management Department, Milton Hospital, Milton, MA. (617) 696-4600 x1360, linda_burke@miltonhospital.org

Fay Crossley, LICSW, Clinical Social Worker in the Care Management Department, Milton Hospital, Milton, MA. (617) 696-4600 x1127, fay_crossley@miltonhospital.org