A 38-year-old woman is admitted to the hospital overnight due to cellulitis. The next morning, the hospitalist on service introduces herself to the patient and asks how she is feeling. The patient angrily says, "It's almost lunchtime, and I still haven't gotten my breakfast. How am I supposed to get better when you're starving me?" The patient has an order to receive a regular diet. Which of the following is the most appropriate response by the physician?

Question

A 38-year-old woman is admitted to the hospital overnight due to cellulitis.  The next morning, the hospitalist on service introduces herself to the patient and asks how she is feeling.  The patient angrily says, "It's almost lunchtime, and I still haven't gotten my breakfast.  How am I supposed to get better when you're starving me?"  The patient has an order to receive a regular diet.  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

In this scenario, the physician has an initial encounter with an angry patient who is upset about an aspect of her care that is not under the physician's direct control. Nevertheless, it is the physician's responsibility to be responsive to the patient's immediate concerns, attempt to defuse her anger, and build the physician-patient relationship. The physician should acknowledge the cause of the patient's distress (ie, hunger), remain nondefensive, and offer to obtain further information that could help resolve the issue (eg, confirming correct diet was ordered; checking with the nursing staff). The physician should maintain a professional demeanor and avoid responding to the patient's anger with comments that may be interpreted as dismissive, defensive, or sarcastic. Being responsive to the patient's immediate concerns is more likely to build rapport, help the patient feel understood and lay a positive foundation for the physician patient relationship. (Choice A) This statement acknowledges the patient's distress but makes no attempt to respond to her concern. (Choice B) This statement offers an apology but inappropriately reassures the patient that the problem has been resolved when this is unknown. (Choice C) This statement may be interpreted as defensive because it focuses on explaining that the problem is not the physician's responsibility. Quickly addressing the patient's needs is more likely to defuse the situation and build the physician-patient relationship. (Choice D) Deferring resolution of the issue until after the examination is unlikely to defuse the patient's immediate anger and could, in turn, negatively affect her cooperation with the examination. Educational objective: Initial encounters with angry patients are best managed by acknowledging their distress and responding to their immediate concerns. __________ References: Defusing the angry patient: 25 tips. (http://www.ncbi.nlm.nih.gov/pubmed/21243886) Managing difficult encounters: understanding physician, patient, and situational factors. (http://www.ncbi.nlm.nih.gov/pubmed/23547575)

A 38-Year-Old Woman Is Admitted to the Hospital Overnight Due