Table 3.
Self-reported impact of emotions in angry encounters and representative quotes (for participants who indicated their emotions influenced their clinical reasoning and decision-making in their angry encounter)*
| Angry encounters (n=38; 24 physicians, 14 nurses)† | ||
|---|---|---|
| Detrimental effects | 35 (92%) | |
| Failed to provide best possible care | 25 (66%) | |
| Delayed or failed to provide necessary exam or treatment | ‘It’s possible that I did not obtain a full history and did not conduct a full physical exam on the patient.’ (45, physician) | 10 (26%) |
| ‘I don’t do as thorough as an assessment and don’t listen as much because of frustration.’ (139, nurse) | ||
| Acted less professionally or compassionately | ‘If you get fired up about a patient, it becomes hard to really put yourself in their shoes and see what they want/need.’ (50, physician) | 8 (21%) |
| ‘… I do feel that because of his attitude and his sex offender status, I did not feel any level of empathy for him whatsoever. I continued to do my job and care for this patient and provide for him anything medically needed, but I did not go above and beyond to anticipate any needs he may have, or out of my way to provide for him the way I would with any other patient.’ (130, nurse) | ||
| Premature closure | ‘I probably prematurely closed my thoughts to them having anything bad.’ (20, physician) | 5 (13%) |
| Failed to address non-emergent concerns | ‘I was ultimately able to provide adequate care, but certainly not superlative care in addressing not only the somatic complaints but the bigger picture concerns for substance abuse and unaddressed personality disorder.’ (38, physician) | 4 (11%) |
| ‘When a patient becomes verbally abusive and manipulative I tend to not go any extra length to provide them with extra services, consults etc.’ (39, physician) | ||
| Provided unnecessary treatment | ‘I felt a bit nervous about his attitude and unreasonable expectations, which may have led me to overtreat (prescribe an antibiotic that maybe wasn’t indicated).’ (21, physician) | 4 (11%) |
| Spent less time with patient | ‘I was tired and rushed that day, so I did not spend as much time with the patient as I should have.’ (16, physician) | 4 (11%) |
| Less focused/engaged during patient care | ‘…When he was panicked and screaming despite anesthesia, my priority was on finishing as quickly as possible rather than on excellent wound edge approximation.’ (26, physician) ‘As I was getting more frustrated and stressed, I was becoming curt with my patients and families and also less focused and efficient.’ (120, nurse) | 3 (8%) |
| General negative impact on providers’ and others’ mood | 22 (58%) | |
| ‘I was overcome with anger and didn’t even want the patient to be seen at that point…’ (126, nurse) | ||
| ‘…The art of the management in this case was all about managing patient (and family) expectations. I think my brusque behavior may have irritated the father, but more impactful, it impacted the young nurse who then revved up the father and the patient.’ (35, physician) | ||
| Miscellaneous (does not fit in any categories) | 3 (8%) | |
*
Codes are not mutually exclusive; 47% of the responses were coded into two or more categories. Percentages that are highlighted reflect the percentage of participants whose responses were coded in at least one category within the highlighted theme or subtheme. Percentages that appear below these reflect the percentage of participants whose responses were coded for that specific category.
†
Seven participants responded that their emotions may have influenced their decision-making but did not include a free-text response.