A 52-year-old man comes to the office for follow-up to discuss the results of his colonoscopy. The physician informs the patient that a cancerous polyp was removed and that there is no evidence of invasive cancer at the resection margins. He is then reassured that he has an excellent prognosis. In response, the patient curses and shouts angrily, "Are you telling me I should be happy that you found cancer in the first place? You don't know what you're doing!" Which of the following is the most appropriate response to the patient?

Question

A 52-year-old man comes to the office for follow-up to discuss the results of his colonoscopy.  The physician informs the patient that a cancerous polyp was removed and that there is no evidence of invasive cancer at the resection margins.  He is then reassured that he has an excellent prognosis.  In response, the patient curses and shouts angrily, "Are you telling me I should be happy that you found cancer in the first place?  You don't know what you're doing!"  Which of the following is the most appropriate response to the patient?

Quizplus · Accepted Answer

This patient is angry and verbally abusive after receiving an unexpected cancer diagnosis. Anxiety and distress likely exacerbate his sense of entitlement and demanding personality characteristics, and the physician must face the challenge of responding to his insulting comments. When patients are upset, they may have difficulty fully processing information. Instead, they may express anger at the physician rather than acknowledging their own fears. The best approach is to defuse the situation by being nondefensive and acknowledging the patient's anger. This should be followed by an open-ended approach that elicits the patient's understanding about his condition and encourages him to express his concerns and fears about the diagnosis that likely underlie his behavior. (Choice A) This statement initially expresses empathy but then assumes a defensive stance, which is unlikely to engage the patient or defuse his anger. (Choice C) This statement assumes that the patient did not understand the information provided, which may be perceived as judgmental. The best initial approach is to acknowledge the patient's anger while exploring his understanding of the results. Reassurance that the cancer was removed would be the appropriate next step if discussion revealed that he misunderstood his prognosis. (Choice D) Suggesting that the patient should calm down is likely to be perceived as condescending and judgmental, leading to further deterioration of rapport. (Choice E) Suggesting referral to another provider may be perceived as an attempt to get rid of the patient. The first step should be to defuse the patient's anger and attempt to preserve the physician-patient relationship. Educational objective: When confronting an angry patient, the physician should use a nondefensive, empathic approach that acknowledges the patient's anger and attempts to explore the patient's underlying concerns. __________ References: Defusing the angry patient: 25 tips. (http://www.ncbi.nlm.nih.gov/pubmed/21243886) Evaluation and treatment of the angry patient. (http://www.ncbi.nlm.nih.gov/pubmed/27733956)

A 52-Year-Old Man Comes to the Office for Follow-Up to Discuss