A 45-year-old woman comes to the office for an initial visit. She has no medical issues. The patient has a family history of colon cancer and has indicated on her information form that she would like to discuss when to get a screening colonoscopy. Her father recently died of colon cancer. The physician is running 2 hours behind schedule due to an emergency at the hospital and is feeling stressed. The office staff alerts the physician that the patient had threatened to leave if she was not seen immediately and then started pacing in the waiting room when informed she would have to wait another 10 minutes. When the physician enters the examination room, the patient exclaims loudly, "It's about time, doctor. How do you get away with running a practice like this?!" Which of the following is the most appropriate response by the physician?

Question

A 45-year-old woman comes to the office for an initial visit.  She has no medical issues.  The patient has a family history of colon cancer and has indicated on her information form that she would like to discuss when to get a screening colonoscopy.  Her father recently died of colon cancer.  The physician is running 2 hours behind schedule due to an emergency at the hospital and is feeling stressed.  The office staff alerts the physician that the patient had threatened to leave if she was not seen immediately and then started pacing in the waiting room when informed she would have to wait another 10 minutes.  When the physician enters the examination room, the patient exclaims loudly, "It's about time, doctor.  How do you get away with running a practice like this?!"  Which of the following is the most appropriate response by the physician?

Quizplus · Accepted Answer

Explanation: This patient is angry about the extended wait time and blames the physician for circumstances beyond the physician's control. In such situations, it is important to remain nondefensive and acknowledge the delay and the patient's frustration and distress. A direct and sincere apology can defuse the patient's anger and help her to refocus on the reason for her visit. During a new-patient visit, it is especially important to set a positive tone that will form a good basis for the physician-patient relationship. Although the patient may behave unreasonably, it is the physician's responsibility to establish rapport. (Choice A) This response inappropriately blames the staff and avoids acknowledging the patient's distress. (Choice C) Although this comment acknowledges the patient's distress, it is premature to bring up her anxiety about her cancer risk as the physician is meeting the patient for the first time. The physician should apologize and then establish rapport with the patient by asking open-ended questions about her concerns. (Choice D) This response is condescending and will likely further damage the physician-patient relationship. (Choice E) This response is defensive as it offers an explanation that may be perceived as making an excuse. It would be better to offer an apology and acknowledge that the physician's lateness has caused the patient's distress. Educational objective: Difficult patient encounters due to circumstances beyond the physician's control (eg, long waiting times) should be managed by acknowledging the situation and validating the patient's distress. The physician should remain nondefensive and attempt to build rapport and preserve the physician-patient relationship. References: Managing difficult encounters: understanding physician, patient, and situational factors. (http://www.ncbi.nlm.nih.gov/pubmed/23547575) Defusing the angry patient: 25 tips. (http://www.ncbi.nlm.nih.gov/pubmed/21243886)

A 45-Year-Old Woman Comes to the Office for an Initial