Difficult communications in OSCEs: angry patients

Hello fellow medics,

So this can be a dreaded station, nothing is worse than walking into an OSCE station with an irate patient. It is not easy, but some simple tips and tricks to help you minimise stress for yourself and the patient/actor are found below.

1) LISTEN TO THE PATIENT

Let the patient (or even relative speak) without interruptions to allow them to get their anger off their chest. Only when they have finished should you start to speak. This will show active listening skills, that you care and that you take them seriously enough to give them the space to talk.

2) EMPATHISE TOWARDS THEIR CONCERNS

Whether the issue here is the patients “fault” “your fault” or a “colleagues fault” do not be defensive. The first thing you should do is apologise for how the patient feels. Reflect their anxieties back to them to show you are listening (and watching!)

“I am so sorry Mrs Smith that you felt so let down by the surgery”

“I can see that you are understandably angry that you received your results one week late”

3) YOU CAN APOLOGISE ON BEHALF OF A COLLEAGUE WITHOUT INCRIMINATION

Always an awkward one. The patient is complaining about YOUR colleague..so do I agree or disagree? What is my stance on this?

You can apologise for what has happened. You do not need to be defensive and say “yes but” etc. You can say that you are sorry for how they are feeling without putting anyone at fault. The most important action here is to (if you are not the doctor being discussed) say that you will discuss with your colleague and maybe arrange a follow up with them. At the end of the day you cannot speak on behalf of someone else

4) TAKE OWNERSHIP OF YOUR MISTAKE

If a mistake has occurred, say sorry. You do not need to explain in detail why things were missed, but acknowledge that it has occurred. Humility and transparency are vital to being a safe doctor and remember the examiner may be your future boss, so don’t cover things up.

5) DO NOT BECOME DEFENSIVE

This will always rub the patient/actor up the wrong way. It never helps in these consultations and many of times I have seen a consultation fall apart due to this. The doctor/student feels anxious and the actor is annoyed. Yes you can explain to them if something has been misinterpreted, BUT this is after building that rapport and getting their side of the story.

5) FOLLOW UP

They love a follow up. This means that you need to state that you will 1) discuss this at the next staff meeting 2) do a SEA (significant events analysis) 3) and can invite them back/email them with what has been discussed at the meeting. This shows that there has been learning and usually impresses the patient/actor and examiner!

6) SIGN POST TO PALS

Yes it sounds odd that you are telling the patient to do a formal complaint. I would only say this if they are asking about it i.e. “So what happens if I want to do a formal complaint”, then you can signpost to PALS, otherwise hopefully with your great consultation skills, you can defuse the situation!

The most important part of this station is being empathic, listening and considering the patients point of view. Marks will be for being understanding and how you made the patient feel!

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happy revision :)