When Patients Behave Badly: The Power of Active Listening
Introduction
There’s no doubt about it, you have a challenging role. You are the ‘gatekeepers’ to the NHS; most patients who access NHS services start their journey by coming through your practice’s front door and speaking directly to you. Patients can be challenging for various reasons that are not in your power to control, such as waiting times for secondary care appointments and even if you can offer an in-house solution you may be dealing with situations such as not being able to guarantee a follow-up appointment with the same GP which adds to the patient’s frustration or general sense of unhappiness. So often, you may feel that you have limited resources to offer your patients.
So, what can you do? I’m going to share with you one of the most useful techniques I’ve taught my clients on how to assertively and firmly deal with difficult patient interactions. So you will come across as the confident, competent professional you know that you are.
Understanding the brain’s role in conflict
Let’s start with a short introduction to the brain and the role it plays, because it’s useful to understand what’s driving negative behaviour in order to deal with it effectively, be that ranting, cursing, shouting, or simply over-talking. And why it’s so challenging to try and communicate with patients and have a rational conversation when they are in that state.
What do I mean? Well, we have two spheres of the brain, the left and the right. The brain is a complex organ, but in straightforward terms, the right deals with emotions, whether that's positive or negative emotions. It's all about the emotions, about feelings. So, when people are angry, they are in their emotional, irrational right brain. It's driven by emotions.
The left brain is involved in logic, problem-solving, and finding solutions.
Why is that important? All human beings process communication in the same way, and Psychologists call this process the ‘communication chain.’ The chain is only complete when one person speaks and is then acknowledged, heard, and understood by the other person. If there is a breakdown at any stage of the communication chain or the speaker fails to join the chain when first communicating with the other person, this will affect the receiver's ability to hear and understand what is being said and there will be a breakdown of communication. In terms of your conversation with the patient, when you first speak to a patient, your job is to ensure that the chain is linked. So how do you do that? Well, by acknowledging the other person, making them feel important, that they matter and that you care. That is what will join the communication chain. Positive feelings. Think about the effect on the patient of walking into the practice reception to be met with silence or a negative facial expression. If you were in their shoes, how would that make you feel and do you think it might have an impact on what happens next?
Let’s look at a story. You are on your way to work, and you decide to get a takeaway coffee in a local shop on the way. You open the door, there’s no one else in the shop and as you close the door, a bell rings, telling the shop assistant someone has entered. You see someone behind the counter. At that point you expect them to look up and acknowledge you, but they don’t. It’s not that they haven’t heard or seen you come in, the shop’s the size of a shoe box, however, they keep their head down and as you walk towards the counter they turn away to put something on the shelf behind them, making you wait until they are ready to serve you. At that moment, how do you feel? Ignored, annoyed, irritated? How do you think your mindset and their behaviour might affect the customer-client relationship? Whatever the reason, their behaviour will trigger negative emotions in you, and this can send you into your emotional right brain. What has happened here is that the shop assistant hasn’t joined the communication chain by simply making eye contact and saying hello, acknowledging you, and even worse than that, they have made an unnecessarily negative first impression and that might even extend to your impression of the shop in general. All is not lost at this point if the shop assistant turns around and apologises for keeping you waiting, acknowledging you and showing genuine concern, as this will join the chain, but some damage has still been done as first impressions are hard to undo.
So, we want to ensure this doesn’t happen to you and the patient.
But it’s not always that easy, is it? Even if you do all the right things, the patient could already be in a negative frame of mind when they either walk into your practice or get through to you on the ‘phone, displaying negative right brain behaviour, so your job is to help them become unstuck and go from the right brain to access their logical, problem-solving left brain so they're not reacting emotionally but responding calmly and they're much more rational. Once you’ve done that, it’s about keeping the conversation flowing and keeping ‘the communication chain’ linked.
So, we’ll look at how this can be achieved. And remember, they are much more likely to listen to what you've got to say once they come out of that emotional right brain because anger blocks rational thinking.
So let’s take a deeper dive into one of three key skills of conflict management. These are:
1. Active Listening
2. Building Rapport
3. Assertiveness
We’re going to look at the first one.
ACTIVE LISTENING
If you’ve received any communication training, you may already be familiar with the term ‘active listening’. I think of active listening as your secret weapon to de-escalate a situation and get the patient on board. There are several levels of listening ranging from superficial to active and empathetic listening. And remember, that if you want to take a deeper dive into this subject, I cover Active Listening in my Communication, Conflict Management and Assertiveness workshops.
In this lesson, we are going to look at how active listening deescalates, whilst poor listening on the other hand can lead to feelings of frustration for the other person. So, when you aren’t engaged in actively listening to a patient, not only can this escalate the problem, but you aren’t hearing and understanding their needs.
In Stephen Covey’s famous book, ‘The Seven Habits of Highly Effective People,’ he defines Habit 5 as “Seek first to understand, then to be understood. However, most people want to make their point first, or are so busy looking for their opportunity to butt into the conversation that they fail to hear & understand the other party.”
Nancy Kline in her book Time to Think says the key to having successful and positive relationships is to Listen, “Listen and then… listen.”
Behaviours to avoid.
First of all, you have to manage your emotions. Why is that important? Well, getting defensive will hinder your ability to deal effectively and professionally with the patient, allowing hurt and anger to cloud everything. Nancy Kline lists the following as behaviours to avoid if we want to have successful and positive communication:
1. Interrupting someone
2. Remember, it’s not a competition, about why they are wrong, and you are right.
3. Skip to the end – Being impatient with the other person and wishing they would get to the point. This doesn’t show respect.
4. Tailgating – Finishing people’s sentences for them. On occasion, this might be useful but often, in conflict situations, if you guess the wrong word, it just demonstrates you don’t understand them or that you weren’t listening.
5. And let’s not forget Body Language & specifically eye contact. Acknowledging someone with the right eye contact acknowledges them and says, ‘you matter’ and we all want to feel we matter, don’t we? Eye contact is particularly important and remember that what you're thinking about that person will inform the eye contact, so being aware of any negative narrative is a must. And this applies to the whole face. Nancy Kline, in her book Time to Think says ‘We often think our face is doing one thing when it's off doing something entirely different, i.e. ‘keep going, I’m interested’ when it’s saying, ‘I’m tired of you, go away.’ She explains that “these expressions are unintentional because you learned them in childhood from your family, so your face is a force for encouragement or discouragement!”
An effective way to remember best practice in Active Listening is this acronym.
LISTEN
· Look interested (Be interested)
· Involve yourself by responding.
· Stay focused on information.
· Test your understanding.
· Evaluate what is not being said.
• Neutralise your feelings - Defensive listening – expecting to hear something negative – self-determined outcome – unfairly assuming negative intent.
Finally, here are a few more important techniques to consider that are covered in more depth in my longer workshops:
First of all, Ask questions. When it’s your turn to speak, summarise what the patient said and then ask them questions. Why is that important? It shows curiosity in their point of view and demonstrates genuine interest. For example, let’s assume you are in the training room, having a break and another participant comes up to you and starts a conversation. You tell them what you do and where you work, and they look genuinely interested and ask you a little more about you; just general chit chat but it’s about YOU. How does that make you feel? Would you then be more willing to listen to them talk about their job?
Here’s an example conversation between a receptionist and a patient that demonstrates this approach:
Patient:
"I'm really frustrated. I've been waiting for weeks to see Dr Jones, and now I find out that I won't be able to see her for my follow-up appointment. I don't want to keep explaining my situation to different doctors every time."
Receptionist:
"I understand how frustrating that must be, especially when you're dealing with an ongoing issue, and as you’ve said, you’ve had to explain your situation multiple times.”
Patient:
"Yes, every time I see a different doctor, it feels like we’re starting from scratch. I just want someone who knows my history and can provide consistent care."
Receptionist:
"I completely understand why you’d want to see the same doctor each time—that continuity is really important. How about I make a note in your records to prioritise booking with Dr Jones whenever possible? Just so you know, Dr Jones works Tuesdays and Wednesdays, so her availability is limited compared to some of our other GPs, so we can’t make any promises but we will do our best. "How does that sound?"
In this exchange, the receptionist summarises the patient's concerns and then asks additional questions to show interest in the patient's experience and explore potential solutions. This approach helps the patient feel understood and valued, while managing the patient’s expectations of what is possible and also moving the conversation toward resolving the issue.
Secondly, Evaluate your own and the patient's communication style. How do you do that? By learning the basic styles people use, why they use them, why they are different to us and how to build rapport by effectively communicating with people who have a different style from us. For example, are they an extrovert or introverted communicator?
In summary, your role as a receptionist is not only about managing appointments or answering calls but about being the first point of contact that sets the tone for the patient’s entire experience. By mastering the skills of active listening, building rapport, and assertiveness, you can effectively manage challenging interactions, ensuring patients feel heard and respected. Remember, the way you handle these situations can significantly impact the patient’s perception of your practice and contribute to their overall satisfaction with the NHS. I hope the techniques shared in this blog will empower you to confidently navigate even the most difficult conversations, leaving a positive and lasting impression on those you serve.