4 reasons why patients may become angry

Hospitals are environments where emotions can run high. These emotions cross all boundaries and can affect physicians, hospital staff, patients and their families. Dealing with an “angry” patient is a common challenge that physicians face.

The first step for a physician encountering an angry patient is to remain calm and allow the patient to express his or her concerns. In my experience, “angry” patients can be viewed as falling into several different categories. By understanding these categories, physicians can begin to identify the root of the anger and take measures to address it.

Why do patients become angry? What are the common “root” causes?

1. Pain. Medical illness is often accompanied by pain, so much so that pain is often considered the fifth vital sign. Assessment and treatment of pain is an important factor for all medically ill patients. Anger is a common emotion in patients with pain, especially chronic pain. It is thought that the presence of significant anger may in fact further aggravate the feeling of pain. Physicians must not only be able to assess pain, but also to weigh the benefits and the risks in prescribing analgesics. When any patient appears to be “angry,” the presence of pain, especially untreated/undertreated pain, must be considered and rectified as a matter of urgency.

2. Fear and worry. Being medically ill, especially if one is hospitalized, can be an intensely destabilizing experience for both the patient and his or her caregivers. In some cases, an unknown prognosis, the occurrence of complications or the impact of the illness on their independence, can make patients fearful about the future. This worry can manifest as anger, and since patients cannot direct their worry or anger toward their illness, this anger may be displaced onto people around them, including hospital workers. Attempting to recognize, and where possible alleviate, their worries is often very helpful.

3. Feeling unheard or uninvolved . Any patient who displays anger in a hospital setting is guaranteed to attract attention. For some patients the expression of anger may actually suggest that they feel “unheard” in the medical setting. They may feel that they do not have enough information about their condition or their concerns have not been addressed. The question then arises, how do we make them feel heard? Do they understand why they are in the hospital? Do they understand what their treatment options are? Do they feel they have been part of the decision-making process? Ensuring that patients feel they are involved in their care can reduce the anger that can arise out of being “unheard” in a hospital.

4. An unidentified medical condition or psychiatric disorder. Some individuals may become very angry or irritable in the context of a medical or psychiatric problem. Withdrawal from an addictive substance such as heroin or the presence of major depression or delirium can present with irritability or agitation. It is important to ensure that patients who present with anger are evaluated for the presence of an underlying psychiatric or medical condition.

Collateral and risk

Obtaining collateral information from their family members, caregivers or other health care professionals is also often illuminating. Ensuring that the medical team is delivering a consistent message to patients regarding their treatment is also useful, as conflicting messages may undermine the patient’s confidence in the medical team.

Anger may suggest that there is a risk of violence. It is therefore important to ensure that an assessment is undertaken to reduce the risk to the patient and people around him.

Summary

In summary, there are many situations where physicians may have to deal with patients who are angry. In most cases the most helpful intervention is to look past the anger and attempt to identify, and alleviate, the underlying reason for the anger. Attempting to do this in a busy clinic or hospital setting can be quite difficult and requires both perseverance and practice.

Arshya Vahabzadeh child and adolescent psychiatry resident. This article originally appeared in The American Resident Project.

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  • Dr. Drake Ramoray

    This. I remember the first time a patient was angry at me as a medical student. It was a patient with cancer whose treatment had been delayed due to an ordering error and who was long overdue for his anti-nausea meds as well as his chemotherapy.

    He wasn’t “feeling” like he wasn’t being helped in a timely fashion, he wasn’t being helped in a timely fashion. The situation was handled by understanding that his needs were not being addressed and treating the encounter as such, not by treating that he “felt”is needs were not being addressed.

  • buzzkillerjsmith

    I had an angry pt not one hour ago. She and the(very nice) MA apparently took an instant dislike to each other. I came into the room and she spent about 3 minutes complaining about the MA. Pt has been seen here before and never had any skirmishing with the staff.

    What to do? Listen attentively and apologize profusely-> mollified pt. In like a lion and out like a lamb.

    Took me years to figure out this strategy.

  • penguin50

    There is another reason why patients may act extremely angry—this can sometimes result from unhappy drug reactions and interactions. As an advanced cancer patient, I swim in a soup of pharmaceutical treatments. I have made the discovery recently that if I take a certain drug more than twice a day (which is far less than what is prescribed for me), I become somewhere between ridiculously irritable and an outright lunatic. It is as though I suddenly possess absolutely zero patience, a quality I usually have in reasonable abundance.

    The first time this happened, Mr. Penguin looked shocked and wisely asked me to please check my drug side effects. Sure enough, an unlucky few experience such effects from that drug. Every day, I ask myself which drugs I can get away with skipping in an effort to avoid these sorts of reactions. Which is worse—feeling pain or acting like a maniac and treating others badly?

    • SarahJ89

      Codeine. You do not want to be in the same room with me if I’ve taken codeine.

  • Suzi Q 38

    I have had a couple of “jaded” doctors.
    I finally said “you win” and dumped them.

    It takes a lot for me (the patient) to “throw in the towel” and not go back to doctors that just aren’t good at what they do and don’t really care anymore. Maybe they were good once. They probably were eager to treat us patients and do their best at one time.

    I have learned, a lot in the last 4 years. I have learned that doctors are being pressured to do so much more than the doctors in decades past.
    I think that their higher than average salaries make management acutely aware of the fact that they have to “earn their keep.” This translates into pressures to perform more procedures, surgeries, treatment, and tests that benefit the hospital or corporation rather than the patient. In a way, they have “sold” themselves out and relinquished any control over their day to day work, patients who depend on them and their future careers.

    The sad thing is that most patients are unsuspecting and have no idea that their doctor may not be as interested in their medical care as much as the prior generation of older physicians. They think that the problem is with themselves alone.

    I used to make excuses for my errant physicians (luckily I have had only two), I would do my research and provide them with the proper studies, and ask direct and pertinent questions regarding my care or lack thereof.

    When it got really bad, I asked myself: “What have you done to deserve this type of care or apathy from your specialist?”

    I finally have come to realize that some doctors are so negative and tired that they do not “have it to give” anymore.

    Learn to recognize the signs. If need be, get another doctor.
    For assistance, call the nurse navigator at your hospital to assist you and document your journey. The purpose is for everyone to realize that regardless of what their personal feelings are at work or how sad and tough the system is, you still need good medical care.

    You are not going to get it if you settle for anything less.

    • Patient Kit

      I don’t think it’s fair to generalize this as a generational thing — that younger doctors don’t care about their patients as much as older docs do/did.

      • Suzi Q 38

        That’s a fair observation.

        I will qualify what I said.
        “For me, my younger doctors didn’t care as much as the older ones I remembered in my younger years.”

        You are right.

  • Suzi Q 38

    “…..They really are unheard, they really are not given enough information, they really have not been permitted to be part of the decision making process….”

    You comments reminded me of an acquaintance who apologized to me by saying ” I am sorry that YOU felt that I was rude,” rather than saying “I was rude to you the other day, and want to apologize.”

  • Anne-Marie

    I see several physical/psychological factors listed here, all of which are entirely accurate, but what about the system itself? There is a lot about the patient experience that can lead to frustration and anger.

    I recently had to leave a doctor I truly liked because the nurse was so awful – I quickly found out I couldn’t trust her to follow through on ANYTHING. The last straw was when I needed to get a referral to a specialist and she just didn’t do it, forcing me to scramble around and come up with an alternate plan.

    I think the author gives really good advice about looking past the anger to find out the underlying cause. It’s easy to assume that when patients and families are angry, they’re being uncivil or overly demanding, when maybe there’s a valid reason for their anger.

  • SherryH

    On the Facebook page for OhioHealth there is a posting from a gentlemen who said he went in the hospital for a minor outpatient procedure, which he thought he had an agreed upon price for, and then later received an additional facility fee bill $33,000 for a total of 4 hours spent. I had a similar, though thankfully for a smaller amount, experience. And you wonder why people are angry? Lies, deceipt and aggregious profits on the backs of sick and injured people. Yes, people SHOULD be angry!

    • southerndoc1

      Corp med at its finest.

      • Judgeforyourself37

        Even supposedly “non profit” hospitals charge a “facility fee” for office visits and care in that hospital. We wonder why Medicare is out of control, we wonder why insurance rates are high? Well for insurance companies greed is certainly a factor, and the same is true for these “non profit” hospitals with their high CEO, COO and other corporate elite salaries and benefits.

  • SherryH

    How often do you think people actually receive the “right bill” for the “right service”? I never have been able to get clear honest answers about cost before agreeing to anything. Every time I think I have it worked out, with the provider and insurance, ahead of time, they slam me with a “surprise”. If you think people are given honest answers ahead of time you are wrong.

  • SherryH

    At no point have I ever thought I should receive care for free. I have TRIED to take responsibility for my care and my share of the bill, but have been met with ongoing dishonesty and contempt for trying to find out what something will cost me before making a decision. Yes I do have insurance, but that doesn’t pay for a great deal. I do think the lack of transparency in costs leads to abuse and greed. Like not disclosing facility fees ahead of time and then charging an infinite amount. I do not think there should be gag clauses either. People have the right to know what something will cost them.

    • SherryH

      People also have the right to be charged fair prices for services and not to be price gouged with 300% markups. A great piece to read on that is Brill’s, “A Bitter Pill”. Personally I wanted to be given an honest answer about what it will cost and I want that cost to be fair…not free. We all deserve that respect.

    • Joe

      I certainly didn’t mean for anything I said to come off as a personal attack on you. I don’t know you. Nor did I say that every one of our patients had this problem. When we do see patients who have complaints or who are angry, these are the top 2 reasons for it.

      • SherryH

        If we had fair prices and price transparency on costs then people like me would have the information to make the right choices for themselves, and that would help a great deal. Then you’d only have to deal with those who don’t want to pay at all for some reason or another. I think that would help eliminate surprises and anger in some, and make things easier for those on both side of the aisle.

      • SherryH

        Joe, if my responses sound like anger I apologize. I haven’t been treated kindly by the health care system.

      • Judgeforyourself37

        Joe, I am a retired RN who worked as a patient educator for surgical patients. I can assure you that someone who is self pay, pays the entire amount unless they try to negotiate with the hospital. Sometimes this works and sometimes it does not. If someone is on Medicare/Medicaid/or has insurance those three entities do not pay the full amount and the hospital has to agree to the amount that Medicare/Medicaid/Insurance pays. Yes, patients pay a deductible of anywhere from $100. to over $3,000.

  • Judgeforyourself37

    Patient anger, also, arises from short staffing. Patients are usually not angry with the nurse him/herself, but the situation that makes it impossible for the nurse to respond as rapidly as she/he would have like to have responded to the patients’ needs.

  • Judgeforyourself37

    It is not just in VA hospitals. Institutional cooking, is often not appetizing, and sometimes downright awful. Some hospitals have excellent food, but that is rare.