How do I identify unhappy patients?


angry patientMD/RN is back!  This new exclusive series on how to care for unhappy patients features our favorite ER doc, Dr. Brady Pregerson, and our favorite sassy nurse, Rebekah Child, RN, donning the velvet gloves to show us how it’s done.
In part one of this three-part series, Dr. Brady describes the many frowns of unhappy patients, and Nurse Rebekah gives advice on finding your way to the heart of the problem.

MD: No matter where you work, you’re going to have to deal with your share of unhappy patients. Sometimes they may be outwardly upset, rude or obnoxious. Other times they may be more reserved, hiding their discontent while they silently stew, before eventually complaining about your care to someone else.

If you’re lucky, the complaint will be informally voiced to another member of your “team” who can give you the heads-up and allow an opportunity to reconcile the situation. If you’re unlucky, however, the complaint will come in written form to your boss or, even worse, a hospital administrator.

Meanwhile, the “silent stewers” may  give you signs that they’re unhappy, but they’re more subtle—perhaps just a sad tone of voice or the lack of a smile.

Of course, we all realize that nobody’s perfect. Even when you’re doing your best to keep the customer satisfied, no one can precisely predict what a patient will or won’t want every time. This is even more true when you work in a hectic environment like the emergency department.

RN: I say for the people who are just unhappy—probably due to watching too many TV shows that have given them unrealistic expectations—they should be heavily medicated with Versed. Then not only will they not mind the wait, but they won’t even remember it!

Okay, before the nursing board comes to revoke my license, I’m just kidding! There are usually very good reasons why patients end up unhappy, whether or not they’re able to articulate their feelings.

If you sense your patient is displeased, the best thing to do is ask some questions. The Press Ganey survey, which is basically a list of questions asked to patients after they’ve received their care, provides some good examples:

  • Did you receive adequate pain medication in a timely fashion?
  • Were you kept up to date during your visit?
  • Were delays in care adequately explained to you?
  • Did your doctor and nurse take the time to listen to all of your concerns?
  • Were your condition and treatment properly explained?
  • Was your privacy respected?

Once you suss out why your patient is unhappy, be honest about what may have caused their displeasure. Think of a hospital like another environment where customer service is of utmost importance – a restaurant. If you’re kept waiting for your food, a server’s explanation that there was a fire in the kitchen will make you feel more forgiving than a vague, “Sorry your burger is late.” Same with a hospital. A patient will, in most circumstances, respond more appropriately to a nurse who is honest with them about why the physician has not been around yet (still in a case, lots of patients to see) or why it took an extra minute to get the pain medication (was in another patient’s room, etc).
ER Pocketbooks

Brady Pregerson, MD
Brady Pregerson, MD, a returned Peace Corps volunteer and winner of the 1995 Wise Preventive Medicine Scholarship, completed his medical school at the University of California, San Diego, and his residency at Los Angeles County General Hospital. He has authored three medical pocket books for nurses and doctors, as well as the educational web sites and Dr. Pregerson currently works as an emergency physician in Southern California. He writes, "Although the ED environment may be quite different from working on the hospital floor or in an office setting, I am hopeful that you can take these tips and apply them to your own specific work situation." You can buy his books on lessons from the ER, including Don't Try This At Home: Lessons from the Emergency Department and Think Twice: More Lessons from the ER, at

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