Dealing with strong emotions

Tips

• 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