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Tips for handling a patient's disruptive family member

Seventy-three percent of baby boomer caregivers are attending all or nearly all of the doctor appointments for a senior loved one. Family members who are angry, aggressive or otherwise disruptive during the patient’s visit interfere with your patient’s care. Use these tips to handle disruptive family members so you can focus on your patients:

Don’t take it personally. When people are fearful or worried, they may be argumentative or aggressive, taking their misplaced anger out on you. Their feelings are usually not about you personally or your ability as a physician. They may be worried about their sick mother, frustrated that previous treatments haven’t worked or they’re experiencing a lack of control over the situation. Arguing with or making demands of the healthcare provider, while inappropriate, may give them a much-needed sense of control. When a patient’s relative starts attacking you verbally, take a deep breath and remind yourself, “This isn’t about me. This person is scared and vulnerable right now.” Then do your best to figure out what’s really bothering them.

Acknowledge the emotions. You may be tempted to ignore the upset family member and rush through the appointment to get the patient and family out the door ASAP. However, avoiding the situation is a mistake. If you don’t address the fear and anger, they may continue to build, causing even more problems down the road. Instead, defuse the tension by acknowledging the emotions, gathering more information and listening to understand. You might say, “I can tell you’re really upset. What’s going on? Did I do or say something that bothered you? I want to support you.” Give the relative (and patient) permission to talk briefly about their concerns and fears. You may not think you have time for this conversation. However, listening is critical for developing trust and building a solid relationship with the patient and family. Chances are you’ll see your patient’s daughter again at the next visit, so spending a couple minutes listening now may save you time in the future. If the family has significant distress, you could refer them for supportive counseling.

Listen reflectively. Express empathy and show you care by telling the family member you understand what they said (verbally and non-verbally). You could say, “It sounds like you’re angry that it took so long to get your mother an appointment. You’re really worried about her diabetes and are afraid she’ll lose her eyesight. Did I get that right? I understand that you’re frustrated, and I’m so sorry you had to wait a few weeks to see me. Let’s schedule your mother’s next appointment before you leave today, so you’ll know exactly when she’ll be coming back.”

Be direct and firm. When family members continue to be aggressive despite your attempts to calm them down, you may need to tell them their argumentative behavior isn’t helping the patient. You can ask them to please hold their comments and questions until the end of the visit when you’ll discuss their concerns. Some physicians ask disruptive relatives to leave the exam room while others let them stay after making it clear that the patient is their top priority.

You don’t need to have all the answers. In some cases, you may not be the right person to address the family’s concerns. If someone is worried about paying their hospital bill, you could refer them to a financial counselor for assistance. In that situation, listen to the relative, acknowledge their distress and tell them that you may not be able to solve their problem. Then steer them toward a person who may be able to help.

Remember that family members are an important part of your patients’ support team. By addressing the family’s concerns, you’re helping improve your patient’s overall care.