Think about the last time a patient yelled at you in anger.  How did you react?  The last time this happened to me I immediately went on the defensive despite years of training in serious illness communication skills.  Afterwards, I thought there must be a better way.

Well on today’s podcast we invite two of our favorite palliative care psychiatrists, Dani Chammas and Keri Brenner, to teach us about going beyond simple communication skills like naming the emotion when interacting with the angry patient (see our podcast on avoiding the uncanny valley for a deeper dive into the dangers of becoming too rote and scripted).  As Keri put it in the podcast, we must go beyond “a hammer and a nail” philosophy to approaching anger by developing a toolkit for anger that is vast and varied.

Dani and Kery present three steps for interacting with an angry patient: 

1. Look within: What is this anger bringing up in me? How is this anger making me feel, think, and react?

2. Ask why: What is underneath the anger for this particular patient? Creating a “formulation” for the patient

3. Act mindfully: Decide what can we do, and how we can respond therapeutically (and no there is no mnemonic for this step)

Here are some other great references we discussed in the podcast:

• Shalev D, Rosenberg LB, Brenner KO, Seaton M, Jacobsen JC, Jackson VA. Foundations for Psychological Thinking in Palliative Care: Frame and Formulation. J Palliat Med. 2021;24(10):1430-1435. doi:10.1089/jpm.2021.0256

• Rosenberg LB, Brenner KO, Jackson VA, et al. The Meaning of Together: Exploring Transference and Countertransference in Palliative Care Settings. J Palliat Med. 2021;24(11):1598-1602. doi:10.1089/jpm.2021.0240

• Brenner KO, Rosenberg LB, Cramer MA, et al. Exploring the Psychological Aspects of Palliative Care: Lessons Learned from an Interdisciplinary Seminar of Experts. J Palliat Med. 2021;24(9):1274-1279. doi:10.1089/jpm.2021.0224

• Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298(16):883-887. doi:10.1056/NEJM197804202981605

• What's in the Syringe?: Principles of Early Integrated Palliative Care

And for those interested in other podcast we did with Dani and Keri, check out the following:

• Therapeutic Presence in the Time of COVID

• Improving Serious Illness Communication by Developing Formulation

• What is Emotional PPE?