Dealing with an angry, upset patient can feel like walking into an emotional storm. The frustration in the room is palpable, and even the most experienced clinicians can feel thrown off balance. While medical training equips us to handle complex diagnoses and emergencies, it often falls short when it comes to managing interpersonal conflict. That’s where the Universal Upset Patient Protocol comes in—a straightforward, highly effective framework designed to de-escalate tense situations, restore trust, and protect your own emotional bandwidth. In this episode, we explore Dr. Dike Drummond’s original protocol, breaking down each step with specific language to use in the heat of the moment. Finally, we’ll add a few practical tweaks to help make these conversations even more natural and effective in real-world practice.
Guest Bio: Dike Drummond, MD, is a physician coach, burnout prevention expert, and creator of the Universal Upset Patient Protocol—a step-by-step framework for managing challenging interactions with upset patients. A former family physician, he transitioned to coaching to address the emotional toll of healthcare on providers. As founder of TheHappyMD.com, he’s helped thousands of physicians improve communication, manage stress, and build healthier professional relationships.
Mentioned in this episode
Awake + Aware. May 5-7, 2025. Bend, OR
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We Discuss:
The Universal Upset Patient Protocol: A Framework for Diffusing Conflict
- The Universal Upset Patient Protocol is a step-by-step method designed to handle patient frustration effectively, whether or not you’re the cause of their anger.
- Recognizing and addressing a patient’s emotional state can prevent an upset from escalating and help maintain control of the clinical encounter.
- Medical training often overlooks conflict resolution skills, leaving clinicians unprepared for emotionally charged interactions that can derail an entire day.
- The protocol is effective about 85% of the time, with the remaining 15% involving patients who may remain upset despite best efforts.
- Key Principle: The goal isn’t to “fix” the emotion—it’s to acknowledge it, create space for it, and guide the conversation toward a constructive outcome.
Step 1: Acknowledge the Vibe and Name the Emotion
- Start by naming what you observe: “You seem really upset” or “I’m sensing frustration.”
- It’s not critical to get the emotion exactly right—acknowledgment is more important than precision.
- This approach helps to diffuse tension because the patient feels seen, even if they correct you about how they’re feeling.
- Pro Tip: Keep your tone neutral and grounded to avoid escalating the situation unintentionally.
- Clinicians often overlook this step, but failing to acknowledge emotions can make patients feel ignored or dismissed.
Step 2: Open the Door for Them to Speak
- Use an invitation like, “Tell me about it.” This simple phrase gives patients permission to express themselves without interruption.
- Resist the urge to defend, justify, or problem-solve immediately—just listen.
- Allowing the patient to vent their frustration often reduces emotional intensity on its own.
- Active Listening Tip: Maintain open body language, nod occasionally, and avoid multitasking during this moment.
- Remember the quote: “People don’t care how much you know until they know how much you care.”
Step 3: Apologize and Show Compassion
- A genuine, non-defensive apology can be incredibly disarming: “I’m so sorry this is happening to you,” or, “I’m so sorry this has happened.”
- This isn’t about admitting fault; it’s about expressing empathy for the patient’s experience.
- You can apologize for how they feel or for the situation itself, even if it’s beyond your control.
- Avoid explanations or justifications here—don’t be tempted to “fix” it yet. This step is about connection, not solutions.
Step 4: Identify Their Need
- Shift from emotional validation to problem-solving: “What would you like to see happen today?” or “What would you like me to do about it?”
- This question helps uncover whether the patient wants a specific action or simply needed to be heard.
- Framing it with “today” keeps expectations grounded and manageable within the current encounter.
- Boundary Awareness: You’re inviting input, not committing to fulfill every request.
- This step transforms the encounter from emotional release to collaborative problem-solving.
Step 5: Clarifying Reflection (Rob O Addition)
- Add a layer of active listening with: “Here’s what I’ve heard you say… Am I correct?”
- Reflecting back what you’ve heard ensures clarity, reduces misunderstandings, and shows the patient that you’ve truly listened.
- This can be especially powerful in heated situations where emotions cloud communication.
- Why This Works: It lets patients know they’ve been heard and gives them a chance to correct any misconceptions before moving to solutions.
Step 6: Set Boundaries and Expectations
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- After hearing the patient’s concerns, it’s time to define the next steps:
- Verbiage options
- “Based on what you’ve told me, here’s what I can do for you today.”
- “Here’s what I’d like us to do next.”
- “Here’s what I’m willing to do.”
- If the patient’s request is unreasonable, maintain respect while setting clear boundaries:
- “I understand why you’d feel that way, but here’s what I’m able to do for you today.”
- Focus on what you can do, not just what you won’t do—this keeps the conversation constructive.
- Setting limits isn’t about control; it’s about maintaining professionalism while respecting both parties’ boundaries.
Step 7: Express Gratitude
- Close the conversation with gratitude: “Thank you for sharing this with me. It’s important that we understand each other.”
- This final step reinforces that the patient’s concerns were valued, even if the resolution wasn’t perfect.
- Gratitude helps shift the emotional tone from adversarial to collaborative, leaving the door open for ongoing trust.
- A sincere thank-you can be surprisingly impactful, even after a tense interaction.
Beyond the Protocol: The Magic of Conflict Framework
- Inspired by Thomas Crum’s The Magic of Conflict, this framework draws from Aikido, a martial art focused on redirecting energy rather than meeting force with force.
- Centering: Ground yourself emotionally before engaging in conflict. This helps maintain calm and clarity under pressure.
- Blending: Align with the patient’s emotional energy to create rapport, not resistance. This doesn’t mean agreeing with them—it means meeting them where they are.
- Redirecting: Channel the intensity of the conflict toward a productive resolution. This is where problem-solving happens after emotional validation.
- Why It Works: This framework shifts the mindset from “winning and losing” to transforming conflict into solution and connection.
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