09/12/2016

MODELS OF CONSULTATION
Medical Model
Health Belief Model (Ideas Concerns and Expectations)
Neighbour Model (Connect, Summarise, Handover, Safety Net, Housekeep)
Tates Model (Reasons for attendance, define clinical problems, explain, manage,
effectiveness)
BARD Model (Behaviour, Aims, Room, Dialogue)
Calgary Cambridge Model
COMMUNICATION SKILLS AND DIFFICULT
PATIENTS IN GENERAL PRACTICE

CALGARY CAMBRIDGE MODEL DOCTOR CENTERED VS PATIENT CENTERED

TYPES OF DIFFICULT PATIENTS FOCUSING ON THE ANGRY PATIENT

Shy patient Explore reasons for anger:
Anxiety (illness)
Demanding patient
L ate appointment
Hidden agenda patient Patient c onc erns that are not being addressed
Not being taken seriously
Teenager patient
Disappointment at lac k of therapeutic suc c ess
Angry patient Misunderstandings (ICE)
Frustration and guilt (not addressing problems sooner)
Fixated ideas
Somatising patient

War is diplomac y by other means.

Carl von Clausewitz

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STRATEGIES AND SKILLS DEFUSING ANGRY PATIENTS

Reflection Remember anger has a purpose: gaining listeners complete attention
you are upset bec ause
Body language:
More effec tive than questions are you upset bec ause...?
Eye c ontac t: non-threatening. Do not raise eyebrows, purse lips, aggressive stanc e
Legitimisation Compartmentalize: deal with main issue first, summarize and check.
I c an understand why you are upset...
I would also feel like this if I were in your position This expression of understanding Acknowledging the imperfections of medical diagnosis and treatment
and legitimising your patient's
Use your own feelings emotion is reassuring to them. It Acknowledging own lack of omnipotence
usually prevents any further
Be patient (anger usually doesnt last long) problems and is a powerful method Establishing limits
for establishing trust and rapport In real threat of physical violence use the panic button
between the doc tor and the patient.
Roger Tate

EXAMPLES? REMEMBER..
Remember the patient is angry, not you!
Rec ognize the signs of anger before it reac hes its c limax.
Remain c alm.
Show empathy.
Express c onc erns for the patient's feelings.
Allow the patient time to c ool off or c alm down if nec essary.
When making statements, use I rather than You.
Remain at a safe distanc e: do not invade the patients personal spac e during the esc alation of
anger
Be sensitive to non-verbal c ues
Soften requests

REFERENCES
GP Online. Consultation Skills Staying calm with angry patients. Peter Tate. URL:
http://www.gponline.com/consultation-skills-staying-calm-angry-
patients/article/1051676(Last access 08/09/16)

Tate P. The doctor's communication handbook [monograph on the Internet]. [place

unknown]: Abingdon : Radcliffe Medical Press, c2003.; 2003. [cited September 9,
2016]. Available from: University of Liverpool Catalogue.