How to manage a patient who appears to be impatient?

Managing an Impatient Patient

Use structured verbal de-escalation techniques immediately, focusing on establishing rapport through active listening, identifying the patient's specific concerns and goals, and offering realistic choices while setting clear expectations—this approach successfully resolves most situations without escalation or medication. 1

Immediate Verbal De-escalation Strategy

The American Academy of Pediatrics provides a systematic 10-step approach that should be implemented sequentially 1:

Step 1: Ensure Safety and Respect Personal Space

• Maintain a non-threatening posture by standing at an angle rather than directly facing the patient 1
• Keep adequate physical distance (approximately 2 arm lengths) to avoid triggering defensive reactions 1
• Position yourself with clear access to exits and ensure other staff are aware of the situation 1

Step 2: Establish Verbal Contact with One Designated Staff Member

• Designate only one staff member to interact with the patient, as multiple voices confuse and escalate agitation 1
• Introduce yourself and your role clearly 1
• Orient the patient to where they are and what to expect next 1
• Provide immediate reassurance: "I'm here to help you" 1

Step 3: Use Concise, Simple Communication

• Employ simple language with short, concrete sentences rather than complex explanations 1
• Repeat key messages frequently, as agitated patients have impaired information processing 1
• Allow adequate time (10-15 seconds) for the patient to process information before expecting a response 1

Step 4: Identify the Patient's Specific Goals and Expectations

Ask directly 1:

• "What did you hope would happen here today?"
• "What helps you at times like this?"
• "Even if I can't provide exactly what you want, I'd like to understand so we can work on it together"

This validates their concerns and transforms them from adversary to partner 1.

Step 5: Demonstrate Active Listening

• Reflect back what you heard: "Tell me if I have this right..." or "What I'm hearing is that..." 1
• Use body language (nodding, appropriate eye contact) and verbal acknowledgment to convey that their concerns are heard, understood, and valued 1

Step 6: Build Empathy Through Agreement

• Agree with their emotional experience: "What you're going through is difficult" or "That would upset other people too" 1
• When you cannot agree with their demands, agree to disagree respectfully: "People have different views on this issue" 1
• Minimize arguing, which only escalates the situation 1

Step 7: Set Clear, Reasonable Limits

• Establish mutual expectations: "We're here to help, but it's important that we're safe with each other and respect each other" 1
• State consequences of unacceptable behaviors in a non-punitive way: "Safety comes first. If you're having difficulty staying safe or controlling your behavior, we will need to [specific consequence]" 1
• Coach the patient on maintaining control: "It'll help me if you sit calmly. I can better understand your concerns if you tell me calmly" 1

Step 8: Offer Realistic Choices to Restore Control

• Provide options that empower the patient: "Instead of [problematic behavior], what else could you do? Would [alternative option] help?" 1
• Link their goals to their actions: "You'd like [desired outcome]. How can we work together to accomplish that?" 1
• Consider small acts of kindness (water, blanket, phone access) that demonstrate goodwill 1
• Avoid deception or bargaining, which damages trust 1

Understanding the Psychology of Impatience

Research demonstrates that impatience represents a preference for immediate gratification over delayed benefits, which can manifest as non-adherence to treatment plans and poor health outcomes 2. Recognizing this helps frame your approach—the patient needs immediate acknowledgment and tangible short-term solutions, not lengthy explanations about future benefits 2.

Common Pitfalls to Avoid

• Never use multiple staff members talking simultaneously, as this confuses and agitates the patient further 1
• Avoid complex, multi-step instructions when the patient is already frustrated 1
• Do not stand directly facing the patient in an aggressive posture—always position yourself at an angle 1
• Never minimize or dismiss their concerns, even if they seem unreasonable—validation is essential for de-escalation 1
• Avoid bargaining or making promises you cannot keep, as this erodes trust and worsens future interactions 1

When Verbal De-escalation Succeeds

The Western Journal of Emergency Medicine emphasizes that when verbal de-escalation is undertaken with genuine commitment, successful outcomes occur far more often than previously thought possible 3. The goal is to help the patient manage their emotions, maintain control of their behavior, and become an active partner in their care—all without coercive interventions 3.

Debriefing After Resolution

Once the situation resolves, briefly debrief with the patient 1:

• Acknowledge their cooperation: "Thank you for working with me"
• Ask their perspective: "What helped you calm down?"
• Discuss alternative strategies if similar situations arise: "What could we do differently next time?"

This reinforces the working relationship and prevents future escalations 1.