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Working with fearful patients- The Fight

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Patients that come from a place of fight are easier to pinpoint, not easier to work with.  The body has a defense mechanism that when put in dangerous, threatening, or fearful situations gets louder, bigger, and more aggressive to ward off what we perceive as a dangerous predator- yes, meaning you.  I know what you’re thinking, “Patients chose to come in.  I don’t force anyone.”  It doesn’t change the reaction they have.  Remember, this is biology and physiology that is so automatic to our systems we don’t even recognize when we are in these modes.  Patients are not choosing their reaction and they are not making a conscious decision to make your life and the team’s lives miserable.

Patients that have the fight response look and sound like this:

  • Move loudly throughout the office, making sure everyone knows they are there.
  • Direct responses, often being borderline rude or curt (they are on the offensive).
  • Appear grumpy and negative.  I refer to them as prickly- like a porcupine with it’s quill’s out.
  • Easily jump into conflict and disagreements with anyone in the office. “Mr. X, isn’t this weather wonderful?”  “What’s so wonderful about it.  It’s so sunny out it’s blinding me!”
  • Use sentence enhancers (swearing), exclamations (Darn it, ‘You’ve got to be kidding me’, etc) and name calling to deflect anyone from noticing their real feelings.

Patients with the fight response are more challenging to navigate through than their counterparts.  Patients in fight mode can be scary, uncomfortable, and mean.  It’s normal to walk away from an experience with a fight patient and need to decompress and regain your composure.  You might want to go as far as dismissing them from the practice altogether.  These are the kind of patients that take you to the brink of, “This isn’t worth it,” and walk away from everything you’ve created.

Handling Fearful Patients

There is a way for you to: 1) not be affected by these types of patients; 2) assure them they are in a safe place; 3) have a mutually positive experience.  Start with these steps:

  1. Accept the patient’s reaction.

    You won’t be able to change their automatic response.  You can change their experience.  Control what you can and influence the rest.

  2. Don’t come from ego.

    This isn’t about you or your team.  The patient didn’t wake up in the morning and purposefully set out to ruin your day.  They are afraid.  If this were a child afraid of what reaction would you have?  Why is it different because it’s an adult? Fears are irrational no matter the age.

  3. Slow down and give space.

    Being in fight mode comes with intense emotions and high energy. Don’t fuel the experience further by talking fast, rushing the appointment to get through it, and matching high energy.  Slow the experience down by talking just a bit slower, move with more intention, sit lower than your patient with rounded shoulders and your hands in your lap (just until the fear has dissipated), and hang back just a few extra inches when you can to give some space.  Balance your patient’s energy, don’t fuel it.

  4. Ask empowering questions to get the patient talking.

    The more you know about them and connect, the greater the chance they will be able to share with you what’s really happening.  If they already knew how to tell you they were afraid they would have.  Help them along by asking the right questions.

  5. Be honest, upfront and just ask.

    If you find the patient’s fear is really getting the best of them and it is derailing the experience, be honest and just ask, “Mr. X, I’m wondering if you are nervous about being here?”  Wait and listen.

Patients in fight mode can be some of the most loyal patients if you can get through the fear and connect.

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