When confronted with an angry patient the practitioner should be prepared to remain calm, interested and concerned. It is important to listen intently and allow time for the patient to ventilate his or her feelings.

A skilful consultation should provide both doctor and patient with insight into the cause of the anger and result in a contract in which both parties agree to work in a therapeutic relationship. The objective should be to come to amicable terms which, of course, may not be possible, depending on the nature of the patient's grievance.

If the problem cannot be resolved in the time available a further appointment should be made to continue the interview.

Sometimes it may be appropriate to advise the patient to seek another opinion. If the angry patient does have problems with relationships and seeks help, it would be appropriate to arrange counselling so that the patient acquires a more realistic self-image, thus leading to improved self-esteem and effectiveness in dealing with people. In addition it should lead to the ability to withstand frustration and cope with the many vicissitudes of life—a most rewarding outcome for a consultation that began with confrontation.

1. McWhinney I. A textbook of family medicine. New York: Oxford, 1989, 96-98.

2. O'Dowd TC. Five years of 'heartsink' patients in general practice. BMJ, 1988; 297:528-530.

3. Elliott CE. 'How am I doing?' Med J Aust, 1979; 2:644-645.

4. Mathers NJ, Gask L. Surviving the 'heartsink' experience. Fam Practice, 1995; 12:176-183.

5. Murtagh JE. The angry patient. Aus Fam Physician, 1991; 20:388-389.

6. Mongtomery B, Morris L. Surviving: Coping with a crisis. Melbourne: Lothian, 1989, 179-186.

7. Lloyd M, Bor R. Communication skills for medicine. London: Churchill Livingstone, 1996, 135-

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