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Dealing with strong emotions

Acknowledge it

e.g. ‘I can imagine you’re feeling very frustrated right now.’

Gather information

and explore what is making them feel that way

Repeat back the reasons

and show empathy, e.g. ‘It’s understandable in your situation. You’ve been through a lot. You’re worried about your relative, you’ve been told you can’t see them, and you’ve been kept waiting for 2 hours.’

Ask if there is anything else

Ask if there is anything else that’s making them angry/upset?


  • Avoid saying ‘I understand’ to an angry patient
  • Counter anger with soft, slow speech
  • Ensure you are at their eye level
  • Don’t interrupt an outburst
  • Don’t take offence personally or become defensive (even if the patient/relative is wrong)
  • Demonstrate active listening (eye contact, nodding, verbal acknowledgements, e.g. ‘Yes’, ‘I see’, ‘Mmm’)
  • With an upset patient, silence and long pauses are key
  • You can say you are sorry to hear something happened, but you should not in general admit guilt or apologise unless you have personally made a mistake
  • Try to get the patient seated, ideally with chairs at 90˚ to each other (not head-on)

Responding to cues/questions

  • Cues can be verbal or non-verbal. They may be subtle and the only manifestations of much stronger feelings – the ‘tip of the iceberg’
  • Dealing with a cue
    • Bounce it back (you must show you have recognised it)
    • Empathise
    • Explore the content of the cue, e.g. ‘Would it be OK if I asked more about that?’
  • Note, in general, don’t try to solve problems – it may well be that you can’t. Concentrate on listening sympathetically and encouraging the patient to open up.

Practise makes perfect, here’s some OSCE stations to try

  1. Breaking bad news – subfertility
  2. Deceased partner
  3. Breaking bad news – HGV driver with seizure
  4. Child vomiting
  5. Child vomiting II
  6. Surgery cancelled
  7. We have even more here

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