An angry relative

Step 1 · Read the instruction

WHAT TO DO

Check the format first.

• 1Instructiontaken together, are the most appropriate response
  Choose three. The set should fully resolve the situation, so think about what the daughter needs by the end of the conversation, not just what sounds kind.

Step 2 · Work out your role and who is affected

WHAT TO DO

Ask what you can and can’t do in your role. This often rules out options that promise too much.

• 2Scenariocovering several wards on a weekend afternoon
  You’re busy and responsible for other patients, so time pressure is real. But you’re also the doctor who is here.
• 3ScenarioYou are not part of his usual team.
  This sets your limits. You can listen, read the notes, explain what they say and pass concerns on. You can’t change the discharge plan or promise an outcome.

The people affected are the daughter, who is distressed, the patient, whose care and information are at stake, and the usual team, who can act on the delay.

Step 3 · Separate facts from assumptions, and find the risk

WHAT TO DO

Look for the real complaint behind the emotion, and for any fact that removes an obstacle.

• 4Scenarioupset and raising her voice
  She is distressed. Nothing says she is threatening anyone, so your response should be proportionate.
• 5Scenarioat the nurses’ station
  This is a public place. A conversation about her father’s care shouldn’t happen here.
• 6Scenariono one has explained why
  This is what she is really complaining about. Her anger is about a lack of communication, which tells you that an explanation must be part of your set.
• 7Scenariohe is happy for his daughter to be informed about his care
  This removes the confidentiality barrier. The question has told you sharing is consented to, so don’t invent a reason not to explain.

Step 4 · Name the tension and write your task

WHAT TO DO

List the separate needs. Each will usually need its own action.

You need to respond to her distress, stay within your role and manage your time across several wards. She needs three things:

1. to be heard, somewhere private;
2. an honest explanation of what is known;
3. follow-up from the people who can change the plan.

Your task: I need to acknowledge her distress privately, give her an honest explanation of what I can find, and make sure the responsible team follows up.

Step 5 · Strike out options with a clear flaw

WHAT TO DO

Remove options that promise what you can’t deliver, overreact, or simply send the person away.

• 8Option Cask her to speak to the regular team on Monday
  C postpones without helping. “The ward is very busy” makes the conversation about your problem, not hers.
• 9Option Fmake sure her father goes home today
  F is a promise you can’t keep. You’re not his team, and you don’t know why he’s been delayed. A broken promise would make things worse.
• 10Option HAsk security to attend
  H is disproportionate. She is upset, not threatening, and calling security would likely escalate the situation.

That leaves A, B, D, E and G.

Step 6 · Work out what each remaining option contributes

WHAT TO DO

For each option still in play, ask which need it meets.

• 11Option AInvite her to a quiet room and listen to her concerns.
  A meets need 1: privacy and listening.
• 12Option BRead his notes and explain what you can find
  B meets need 2, which is her actual complaint. It is within your role, and the patient’s consent makes it appropriate.
• 13Option ELet the responsible team know about her concerns and ask them to contact her.
  E meets need 3. The people who can change the plan hear about it, and they are asked to contact her.
• 14Option DExplain that you were not involved in the decision
  D is true, but it gives her nothing she needs. On its own it sounds like deflecting responsibility, or even blaming colleagues.
• 15Option Ghow to make a formal complaint
  G isn’t wrong: telling someone how to complain respects their right to do so. But she hasn’t said she wants to complain. Offering a process before giving her an explanation can feel dismissive.

Step 7 · Build a set of three and test it

WHAT TO DO

Test the set for coverage, compatibility and necessity, then try swapping the weakest choice.

Provisional set: A + B + E.

• Coverage: she is heard in private, given an explanation and promised follow-up from the right team.
• Compatibility: they fit together naturally: listen, explain, then pass it on.
• Necessity: without B, she still has no explanation. Without E, nothing changes. Without A, the conversation happens in public and she may not feel heard.

Test the swaps. Replace B with D, and she gets “it wasn’t my decision” instead of an answer. Replace E with G, and she gets a complaints process instead of contact from the people who can act. Neither swap improves the set.

What could change the answer

WHAT TO DO

Ask which fact would change the set.

• If the patient had not agreed to share information, B would become inappropriate. You would focus on listening and passing on the concern.
• If she became threatening, safety would come first. Withdrawing and getting help, which might include H, would move up.
• If she said she wanted to make a formal complaint, G would become one of the most useful actions.

The exam-speed version

1. Choose three, together.
2. She’s upset, not threatening. The real complaint is “no one explained”. Consent is given. I’m not his team.
3. Needs: privacy and listening, an explanation, follow-up.
4. Strike out C (postpones), F (promise) and H (overreaction). One option per need: A, B and E.

Take this into your next question

Lesson: look for the complaint behind the anger. Here it was “no one explained”, so the set had to include an explanation.

When it applies: angry patients and relatives, and complaints. See angry patients and relatives.