The Importance of Patient Communication


Finding out the reason for an unhappy patient or customer is key to putting the problem right – or at least trying to put it right. Ignoring it will not make it go away, and it won’t help good relations in the future.

Often the main reason for a unhappy person is down to lack of communication and this can often lead to outbursts of anger, frustration, arguments and a possible complaint. Whilst you are not there to take abuse, you have to have a listening ear, an open mind, and an apology if you feel that it is appropriate.

What you have to remember that people attending surgeries or clinics are often unwell, in pain, anxious, or suffering with mental issues or they may be relatives or friends of the patients concerned about their wellbeing.

Its how you deal with a complaint that will determine how far it might go.

A good example of a breakdown in communications happened to a friend of mine the other day.

My friend had to go to our local hospital for an epidural injection. She received an appointment for 11.00 am – She telephoned and asked if she could have an earlier appointment. She explained that a friend who would be taking and collecting her had another appointment early that afternoon. She explained to the clerk that she had 2 previous 8.00 appointments and she had been seen and out by 11.00. The clerk was very helpful and said she would send out another appointment, which she did. It was for 08.00 – perfect.

We arrived at 07.55 to get her booked in. We went into the admissions department to find that there were about 40 other people sitting there already, and more following in behind us. There were people standing in the corridor, as there were no more seats.

The bookings clerk came to the door and shouted *who’s next* – there seemed to be no order at all. I noted who we had walked in behind and I closely kept an eye on them and my friend followed in after they had been seen. Tempers were rising in the waiting area, and I am sure blood pressure taking a rise too. The system was in a total mess.

No apology from the clerk when my friend went in about the long wait. The clerk knew people were not happy and did all she could to avoid any eye contact. She never took her eye off the computer all the time it took to book my friend in.

We went along to the ward and a nurse took all the necessary details. She asked my friend to get ready, as she was due to go down for the injection fairly quickly. We both laughed and said that we probably would have time for a coffee afterwards before my next appointment.

My friend sat and waited, the curtains were around the bed so all we could do was sit and listen, we heard other people being booked in, and going down for their procedures – I realised that there were more than one doctor on so didn’t think too much of it.

We sat and waited a bit more, people were coming back up, getting ready and going home, there were more people arriving. A nurse came in and spoke to one patient telling them that there were two people in front of them and they would be 3rd to go down. Perhaps my friend was the first or second patient – apparently not – we were still sitting there when that patent went down. She came in and told another patient they were next to go down.

It got to 11.00 and my friend was very conscious of the time. I tried to reassure here that I could wait a bit longer, but she went out to find someone to ask what was happening. She met a nurse who I can only say was not very helpful at all.

My friend explained about me having another appointment, the nurse said that we should have come prepared to wait, this was a day ward and my friend should have expected to be there for some time.

My friend explained that she had spoken to the clerk on the telephone when booking the appointment and she didn’t mention anything about the possibility she might be there for the day and there was nothing to indicate that on her appointment letter when she received it.

My friend explained about her previous 2 visits and that she had 8.00 appointments on both those days and both times she had been seen and out by 11.00.

The nurse said that she must have been *lucky* those times.

The nurse went on to say that if she were seen fairly soon that she would be done and out within half an hour – but then went on to say – of course you still could be here for a good while yet.

Never once did the nurse offer to go and see where on the list she might be. She really did not want to be bothered. She really was not any help at all.

So, my friend worried about me getting to my next appointment told the nurse that she was sorry but she could not wait any longer – the nurse just said “well that’s entirely up to you”

My friend came back, got dressed and we left. She was extremely upset, and angry at the way the situation had been handled. I felt bad that I could not have waited any longer with her.

She is a pretty laid back woman, but of course this could have been someone that might not have that accepted the situation so lightly and of course could have caused a unpleasant situation.

What could have been done to make this situation better?

  1. When my friend phoned to rearrange her 11.00 appointment to an earlier one she explained why this was. The clerk taking the call should have explained there and then that she could not expect to be out by 11.00. If she had been told this she had a choice, she could have :
  2. made the appointment on another date, or
  3. asked someone else to take and collect her, someone that didn’t have a problem with staying all day.


  1. The admissions clerk never once apologised for the delay when booking her in. She was asked to be there for 8.00 which she was and was kept waiting an hour standing in a corridor when no chair – a simple “sorry to keep you waiting” would have been simple thing to say but very effective. Often by doing this it defuses the situation, it is very hard to be angry at someone that is being helpful and pleasant.


  1. The clerk was working on her own trying to book people in; perhaps she should have been given extra help at this busy time. Was this being fair to her – expecting her to deal with such a great volume of people? And of course having to deal with angry patients.
  2. People were starting off their admission to hospital getting uptight, angry and the possibility of their blood pressure being high. Not fair to put that extra pressure on a patient.


  1. Why wasn’t my friend kept informed of when she was going to be seen, especially when we could hear other patients being told when they were going down. Was one nurse dealing with patients differently to another? Were doctor’s lists being dealt with differently to others? If so that simply isn’t good enough. Everyone deserved to be treated the same.


  1. The nurse could have been a bit more understanding; instead of trying to help my friend she was completely defensive every time my friend tried to say something. Had the nurse taken the time to go and find out where on the list my friend was (and if she was next or the one after she would have stayed) but it was clear to my friend the nurse was not going to do that.

I feel that this whole situation from start to finish resulted in a lack of communication and could have been handled so much better at various stages from the booking, admission and the appointment.


What do you think?



© 2011-2017 Reception Training all rights reserved

Is your Practice/Staff at risk #SocialMedia


Many of us use social media, Facebook, Twitter, LinkedIn and more. Most of us use it for social purposes, sharing news, pictures, keeping in touch with family and friends, and some of us use it for business purposes.

There is no doubt about it social media is a marvellous thing but it also has a darker side. People sharing information and pictures without the permission of others, to comments being made that could result in bullying or even worse.

I have a friend who was mortified last Christmas to find that pictures that had been taken on a Practice works night out when she was “a bit worse for wear” had found their way onto her Facebook page. She had a few too many drinks and unfortunately tripped up a curb, someone took a picture and thought it would be funny to post this with other pictures of the night on their Facebook page. Unknown that these pictures had been taken; she only discovered them when she was tagged into the pictures. This resulted in he sons, husband and other members of her family and many friends seeing her in pictures she would rather them not have seen. She was not happy and it in fact caused a row at work on the Monday. There was bad feeling between the two for some time, and this in turn affected the moral within the team. The team divided in their opinions some feeling that the person who had posted the pictures had done no wrong, and some feeling that my friend was right in feeling angry. The row developed and a complaint to the Practice Manager and it all got very unpleasant.

Another article I found interesting recently was a Doctors Practice displayed a notice in their surgery asking patients not to use Facebook or Twitter to complain about their service. The notice asked patients if they had any complaints or comments about the surgery would they please contact the Practice Manager as any comments on social media sites may be seen as a breach of their zero tolerance policy. The surgery said in the notice that they would be happy to deal with comments/complaints in the usual way.

The “zero tolerance policy” referred to appears to be NHS guidance on dealing with rude, abusive or aggressive behaviour towards staff.

Apparently the online comments about the surgery named staff and swearwords were used and this what prompted the decision for the practice to put the notice up.

I think the practice was right in asking patient not to use social media for this, as the practice would not have been able to respond to any of the comments because of confidentiality issues. If staff were named this could have been seen as a form of bullying, and the staff member would have every right to feel threatened about it.

see a recent blog with a similar story :

The Threatened Receptionist

There are other stories that have recently been in the headlines, which have involved Facebook, a Neapolitan woman following a marital row her husband demanded that the photographs of their honeymoon be taken down from her Facebook page. His argument was he had not given his permission to publish them, and he even took her to court over it. The Naples court has not only agreed with him but the wife may have to pay him damages. The pictures were taken on the couples honeymoon 10 years ago and included photos of the couple.

Another article recently has also highlighted the importance of holidaymakers sharing their plans on social medial. It could be read and used by criminals planning a burglary.

This information can be seized by thieves – from research said that some 78% of ex-burglars said that they strongly believed social medial platforms are being used to target property.

I think we all need to be aware of the repercussions of staff sharing information on their personal social media sites – especially if it involved their workplace. It could be a very interesting topic to have on your next Receptionist Meeting to discuss using pictures on social media that might be anyway involved their place of work. But most important as an employee they must understand never get drawn into any arguments about their place of work on any social media sites.

Perhaps you could put something about social media usage in your staff contract.



© 2011-2017 Reception Training all rights reserved

How To Avoid Workplace Anger/Violence (part 2)

Are Patients Waiting Too Long?

Research has shown that long waiting times can lead to angry/violent behaviour. So keep your patients informed, give a reason for the delay and apologise when necessary – please do not ignore the waiting patients (see blog: When The Doctor/Nurse is running late. )

Does Your Patients Feel They Have A Method Of Complaint?

Provide a well-advertised complaints procedure in your Practice Leaflet. Quite often a Receptionist can deal with a complaint before it goes to Management level.

Always offer the patient a complaints form. Ensure that all your Reception team knows where the complaints forms are kept. No complaint should go to the Practice Manager without being offered a complaints form first.

Most people when offered a complaints form will decline, and even when they do except a complaints form will probably not return the completed form. But it is important that they have that choice to make.

Are You Or Your Staff Helpful and Courteous?

An abrupt or indifferent receptionist and lack of information can often lead to frayed tempers.

Do You Think Your Receptionist Makes Things Worse?

First rule; do not get yourself into an argument. An argument may cause anger to escalate into aggression and perhaps violence. Have you as a team discussed ways to prevent or defuse such situations? Ensure that all staff have clear guidelines – this will help them deal with such a situation.

Is the Waiting Room a Calm and Comfortable Place?

Consider ways of reducing boredom, up to date magazines. Toys for the in the play area. Posters and Notices on the wall. Plenty of seating. Make it comfortable.

A local A&E Department recently spent a large amount of money re designing and updating their A&E Department and found that this reduced the vandalism by a considerable amount. Both patients and staff found it a more relaxing environment to be in.

Can Your Staff Recognise The Warning Signs?

Staff need to be aware of this at all times. If dealing with a patient who is known to be hostile, make sure you are in a position to summon help or make an escape if necessary. Bring it to the attention of others if necessary.

Does your Practice have panic buttons? Ensure that all Locums and new staff are aware of where they are situated.

Are You Aware Of Stranger Danger?

Be extra cautious if an unknown temporary resident is fitted in at the end of surgery. Warn the doctor/nurse that the last patient is a temporary patient. It has been known that a few patients are looking for drugs will book a late appointment and not complete the temporary residents form out correctly which means that the Practice has no relevant information on the patient. This is not to say that every temporary resident is like this – but there are the odd few out there.

Is Information Shared?

Everyone working in the practice needs to know which patients might pose a risk. This will apply to doctors working at another surgery for the out of hours. Especially inform all other surgeries if you have a temporary resident causing any problems. If you have a violent patient you should inform your local PCT/Health Authority.

Can The Waiting Room Be Seen and Controlled By the Receptionist?

Try to ensure that there are no nooks and crannies where people are sitting out of sight. If someone is getting agitated or poorly the Receptionist should be able to notice the signs and deal with it appropriately.

Are You Providing Weapons?

Do you equip your surgery and waiting room with items that can easily be used as weapons or missiles?

  • Paper opener
  • China Cups
  • Heavy objects such as stapler, paperweights
  • Metal toys in the children’s area
  • Sharp objects

Always ensure that potential items are out of reach.

What Should You Do If the Patient Becomes Aggressive?

  • Avoid direct confrontation and try to defuse the situation. Listen and show you are listening to their point of view – do not argue.

Can You Defend Yourself?

  • Avoid physical contact.
  • Call on others for support
  • Quite often if there is more than one person in front of the aggressive person they will calm down a lot quicker. If you hear a patient getting aggressive at the front desk, just go over to the receptionist dealing with the patient and just stand and observe, do not say anything, often this is enough to calm the person down.
  • If the Receptionist cannot deal with the situation then you might need to step in and take over.

People who are most effective in dealing with aggression understand something about the psychology of people. They understand why make people tick and recognise that human beings have basic animal instincts, which often come to the fore when they feel threatened or feel frightened or angry.

The options that our animal instincts provide are either FLIGHT or FIGHT.

Many things may affect which option we choose but some things which will increase the likelihood of choosing FIGHT are:

  • Feeling our personal space is being invaded
  • Feel physically threatened
  • Feel that our exit path is blocked.

One of the most effective ways of diffusing this natural response is to deliberately signal that you are not going to respond in an aggressive way. This may not be easy when you are probably feeling threatened yourself, but the following actions will help to signal non-aggression to others.

Give the other person space – If you increase the distance between you and the aggressor it will lessen the feeling that their personal space is being invaded and reduce the feeling of physical threat and open up their exit path. It also gives you a greater range of options should the situation suddenly change.

Relax your own posture – you can reduce your own aggressive signs by dropping your shoulders, adopting an open stance and allowing your arms to drop. Such action will probably feel unnatural given the situation but it will quickly reduce the aggressor’s feeling of being intimidated.

Avoid sudden movements – remember that heightened emotion will make an individual jumpy and ready to defend, and that quick or sudden movement might trigger an instinctive reaction.

Reduce eye contact – Sustained eye contact is a very aggressive signal in these types of encounters. You should avoid gazing intently into the aggressor’s eyes.

The above four behaviours will reduce the potential for aggressive situations to turn into violent confrontation. However, they do not, on their own, resolve the encounters successfully. Successfully resolution can be achieved by:

  • CALMING the individual and then building
  • RAPPORT with him/her to finally achieve
  • CONTROL over the situation

This sequence is very specific. Successful control of a situation cannot be achieved by trying to achieve rapport with a person who is still very wound up by the incident itself. You must calm the person down before he or she will be receptive to your attempts to build a rapport.


A common mistake, which is made at this stage, is trying to deal with the reason why the person is being aggressive. In fact you should try to deal with the emotions that the person is bringing into the situation. Trying to deal with the reasons why before you calm the emotions will only service to increase the tensions and set off an escalation of the incident.

It is vital that you as the person seeking to control the situation are fully in control of your own emotions and reactions. This is not easy because you are not immune to the situation and you may be feeling fear, excitement or anger. But your ability to control your own emotions, particularly your anger will have a vital impact.

Many incidents involving aggressive people take place in public places where the aggressor has an “audience” and it will help the situation a lot if you make the encounter a one to one situation where the aggressor will not be able to “play to the audience”. Most of all, do not put the aggressor in a situation where he or she will be seen as losing face to the audience.

In the early part of this stage, what you say in your efforts to calm the individual is probably less important than how you actually say it. How well you communicate non-verbally will be very important in sending calming messages to your aggressor.

There are several non-verbal behaviours which can help to signal non-aggression and encourage the aggressor to calm down

  • Move slowly – sudden, quick or unpredictable movements can sign aggression particularly to someone who is already tense and feeling threatened.
  • Allow space – respect the aggressor’s “personal space”. Moving into a person’s personal space is very intimidating and almost threatening.
  • Reduce aggressive signals – finger pointing, sustained eye contact, arms folded, hands on hips are all gestures which heighten tension rather than reduce it.
  • Deliberately adopt  “friendly” gestures – extending your arms with the palm of your hands outwards, dropping your shoulders, gentle voice tone, an open interview stance and your head to one side rather than full on – these will help to signal to the aggressor that you do not seek to be aggressive.

When you have managed to calm the aggressor to a point when you feel they are able to listen to you, then you can move into the next stage of building rapport.


This is really about winning the aggressor’s trust. If you are to gain effective control of the situation then it is crucial that the aggressor feels that he or she can trust you. This will involve showing empathy towards the aggressor.

This means letting the person know that you can appreciate his or her view of the world and the particular situation they are in. This is distinct from sympathy and agreeing that their view is the right one. Showing empathy can be achieved by simply reflecting back to the person what they have said.

Be careful not to use emotive words or phrases which emphasises failure of loss of face like:

“That was a pretty stupid way of carrying on wasn’t it?”

Show the individual that you are a person too. This may involve giving a little bit of yourself away to encourage the aggressor to talk and to be more open.

By this stage you should be dealing with a much more rational person who is amenable to reason and is listening to what you are saying. If you are not – then you need to continue with the “calming” skills until the person is able to be more rational.


Remember: Patients are not always right but they ARE important. Show them they are important by the way you treat them.