Navigating Angry Conversations

Professor Fallowfield opens the activity by telling the learner that healthcare professionals often report that handling angry patients is one of the most challenging aspects of their job. And, while these situations are relatively rare, they can have a significant impact.

She asks the learner to think back to the last time they had an encounter with an angry patient, patient’s family member or member of the public and describe the situation in their own words. The learner can listen to their avatar retelling this story, if they wish.

Professor Fallowfield explains that a doctor’s response to highly emotional patients can affect how the patient discloses symptoms, recalls given information, agrees on treatment options, adheres to treatment plans, etc. 

Since we all respond to anger in different ways, the first step towards being able to handle angry patients more effectively is to understand our natural inclinations.

In this activity, learners engage in a discussion with Professor Fallowfield about a time when she had to handle a conversation with an angry patient. As Lesley’s story unfolds, learners are invited to comment on what they would have done in this situation. 

As her story comes to an end, Professor Fallowfield provides tailored feedback about how the learner’s responses might be interpreted by patients and the effect that this might have on the doctor-patient relationship. She then recommends an appropriate behavioural technique that the learner can use to stay calm, think more clearly and defuse - not exacerbate - similar situations in the future.

Learners meet Junior Doctor, Ambika Kaling, a former student of Professor Fallowfield. Ambika has already experienced her fair share of angry encounters and has learned various techniques for staying calm in hostile situations.

Ambika coaches the learner in the personal calming technique that best suits the learner’s natural response, as identified in the previous activity.

There are three techniques that Ambika can teach:

• Depersonalisation - recommended for learners who try to control or dominate the situation
• Grounding - recommended for learners who react in the moment with acute stress response
• Box breathing - recommended to help learners who already react with empathy and emotional intelligence to care for their own wellbeing as well.

In this activity, the learner witnesses a challenging consultation between Ambika and her patient, Lucy.

Lucy has already had a series of diagnostic tests and Ambika is trying to explain the next steps. But Lucy’s husband, Joe, is becoming increasingly angry because (among other things) they have been at the clinic for 3 hours and still don’t have a definitive answer…”

While the learner watches, they click to identify the anger signals that Joe is exhibiting. Visual feedback indicates if the learner has correctly identified a behaviour or missed one that has just passed.

At the end of the animation, summary feedback is provided, with a panel of buttons indicating which events were identified. Clicking on a button rewinds the animation to the corresponding instance and provides additional text information about its significance.   

Tailored feedback is provided by Professor Fallowfield at the end.

Now the learner ‘bodyswaps’ into Ambika’s avatar to witness the consultation through Ambika’s eyes and ears.

The observation scene is repeated and the learner is encouraged to practise their personal calming technique with the aid of a heads-up display (HUD). Depending on their recommended technique, the following will happen:

• Depersonalisation - Each time a cue word or phrase is uttered, the word is added to an image of a bucket, floating between them and their patient.
• Grounding - A HUD of the foot outline appears and along with instructions to ‘Plant your feet’, ‘Feel the ground supporting you’ and then an animated dot traces the outline of one foot.   
• Breathing - An animated box is displayed in the HUD with an instruction to ‘Breathe in’ for a count of 4, ‘Hold’ for a count of 4, ‘Exhale’ for a count of 4, ‘Hold’ for a count of 4.  This repeats 3 times, then disappears.

The learner can skip the the end of this activity when they have spent enough time practising or they can try one of the other techniques, then move on.