Today was a bad day. A high-maintenance patient who has been difficult in the past had a meltdown in our waiting room (which was full), yelling at our receptionist for having to wait longer than they would've preferred.

Now I realize the ball does get dropped in a busy practice from time to time. Given the sensitive nature of our work, I am relieved when it amounts to something relatively trivial like accidentally keeping someone on hold, or losing a call. I know those things are important to the person-in-question, but it's nothing compared to, say, a wrong prescription.

Our receptionist handled the situation like a professional, but later she confessed to me that she was completely unnerved. I told her she did fine, and shared with her a four-step process for dealing with difficult patients that I printed off of the Texas Medical Association website:

1. Listen Attentively. Spend several minutes letting the patient tell the whole story without interruption. Be careful not to become defensive, react sarcastically, or appear rushed. Use good eye contact, and take notes, if appropriate. If the patient gets off track, use phrases such as: "Tell me more about …," "Then what happened?" or "How did you feel then?" These phrases invite the patient to continue the story rather than start over at the beginning.

2. Show Concern. After the patient has completed the story, show appropriate empathy or understanding for the situation. Use phrases such as: "I can see how you might have gotten that impression of us," "I can see why you're concerned," or "I'd feel that way, too, if I were in your shoes." You don't have to agree with the patient's story or point of view. Simply show understanding for the situation. The benefit of listening and showing empathy is that the patient begins to feel understood and respected as a person, and that usually lessens emotions.

3. Clarify Details. The next step is to clarify any details or points in the story that are important to reaching a solution. Focus on those items that give you information and clues about how to approach a situation.

4. Respond Assertively. Finally, once you have a clear understanding of both the facts and the emotions of the situation, you can choose an appropriate response. Use an "ideal solution" question such as: "What would you like me to do to solve this problem?" or "What would be your ideal solution to this problem?" The patient may surprise you by suggesting a perfectly acceptable solution. Using the patient's response as a starting point, negotiate the best possible agreement. Be clear about your policies and possible exceptions, outline the patient's choices, and work toward a solution.

The receptionist mainly did the first two, since the problem wasn't serious, and the patient was just venting. Still, the key for such incidents is to be as prepared as possible. After reading the above list, our receptionist made a copy and taped it to her computer.

You know, I can't get my kids to fill the dishwasher or make their beds, so anytime someone listens to me, I feel like doing a little dance.