Aggressive patient

Rules for delivering negative information

Communicating with a patient who may display aggression or go into a state of shock requires strict adherence to the rules of information delivery. Information must be provided in strictly metered portions. The physician must deliver information in small blocks and constantly monitor how correctly the patient understands what was said.

It is strictly forbidden to use wording that eliminates hope. Phrases like "There is nothing we can do" are unacceptable even under the most unfavorable prognosis. If the possibilities of radical therapy are exhausted, the physician is obliged to offer palliative care resources. Its main goal is to maximize the relief of suffering: ensuring adequate pain relief, assistance with eating, maintaining basic self-care skills, and, consequently, improving the quality of the patient's remaining life.

Empathetic responding (Step E)

This is the most difficult stage of interaction, requiring the specialist to adequately respond to strong emotions. In response to bad news, the patient may demonstrate rage (actively searching for someone to blame), deafening silence, crying, disbelief, feelings of loneliness, fear, or profound grief.

Physician's verbal tactics:

• Naming emotions: it is necessary to voice aloud what the person is experiencing (e.g., despair, fear, or helplessness).
• Showing empathy: supportive phrases should be used, such as "I want to share your sorrow" or "I see that you have gone through a real shock."
• Normalizing the reaction: it is important to relieve the person's destructive sense of isolation. It must be emphasized that their aggression or grief is entirely natural: "Anyone in your place would experience shock," "Many patients have gone through this experience."

Non-verbal tactics: Moderate signs of sympathy are permissible, such as a light touch or a pat. However, they must by no means be intrusive or overly prolonged. The physician should avoid any fussiness and excessive drama, as this only prevents the patient from pulling themselves together and calming down.

Reducing emotional intensity

To stop a fit of rage or panic, the physician must steer the emotions in a logical direction. To do this, it is necessary to analyze the condition and identify its true cause using prompting questions. Effective questions would be: "What are you most worried about?" or "What specifically are you afraid of in this situation?"

A critically important rule: the specialist must encourage the interlocutor to talk about their feelings until the heat of passion subsides. It is strictly forbidden to move on to the next stage (discussing medical plans) while the patient is in a state of affect.

Treatment strategy and concluding the conversation (Step S)

When the emotional background is stabilized, the physician must directly ask if the patient is ready to discuss further steps right now. If consent is obtained, the conversation algorithm is structured as follows:

1. All available therapy methods and their clear advantages are announced.
2. Possible risks, complications, and side effects are discussed in detail.
3. The plan to minimize these effects and the subsequent rehabilitation program are explained.

Special attention is paid to managing the fear of pain. Since the fear of physical suffering is one of the strongest, the physician is obliged to detail the measures that will be taken to eliminate the pain syndrome. In conclusion, it must be emphasized that absolutely all modern medical resources will be mobilized to help.

Due to the stress experienced, memory functions specifically: most of the data is simply not absorbed during the first conversation. Therefore, the physician needs to repeat all stages of the explanation a few days later.

Working with anxiety and relatives

Anxiety is a baseline and very frequent response to illness. It performs a crucial protective function: it warns of real danger and deters reckless steps. If anxiety is completely absent, it manifests as dangerous nonchalance. Such a person is highly likely to stop treatment and cease following prescriptions.

When communicating with relatives (if bad news is being broken to them), the physician must explain how exactly they plan to convey the essence of the diagnosis to the patient themselves. Strict rule: the specialist has no right to make tacit agreements with loved ones about what part of the truth regarding health can be concealed from the patient.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Palliative care: pain management and maintaining quality of life.
• Features of information retention in a state of emotional shock.
• Verbal techniques of empathy and normalization of the patient's reaction.
• The danger of a complete lack of anxiety in patients with complex diagnoses.

Other topics in the section "Chapter 31. Psychologically Complex Situations in Medicine"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.