Showing frustration at the ER could affect your care

New research from UMass Amherst suggests patient anger can raise physicians’ stress levels and shape medical interactions.

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Long waits. Delayed care. Overworked staff. America’s emergency departments are under constant strain. Increasingly, they’re also on the front lines of broader social and economic crises, from rising medical costs and lack of insurance to growing mental health and addiction needs.

As a result, frustrated patients often take their anger out on the people trying to help them.

“All those factors fuel not only different emotions, but also a lot of potential errors,” said Linda Isbell, a social psychologist at UMass Amherst.

In Isbell’s new UMass Amherst study — co-authored by Nathan Huff and six others, and recently published in BMJ: Quality & Safety — suggests patients’ frustration can amplify that pressure, raising doctors’ stress levels and potentially influencing the care they provide.

The study worked with 134 experienced emergency room physicians to complete a randomized online simulation in which they treated pre-recorded patients exhibiting either calm or irritable behavior. Doctors reviewed medical records, ordered tests, received results, and made diagnoses before reporting their stress levels and emotional responses.

Physicians reported more anger, anxiety, and fatigue, and less empathy and engagement, when treating irritable patients. They were also more likely to believe those patients exaggerated their pain, withheld accurate medical histories, and were less likely to follow treatment plans.

Despite those differences, the study found physicians were just as likely to make the correct diagnosis and clinical decisions regardless of a patient’s behavior.

Isbell said the findings shouldn’t be interpreted to mean emotions have no effect. The physicians in the study were highly experienced and may have developed strategies for handling difficult encounters.

More importantly, she said, doctors still viewed irritable patients differently. Even if those patients receive the correct diagnosis, they may be less likely to receive adequate pain management or develop trust with their provider. These factors can discourage future care and widen existing health disparities.

While Isbell said patients should try to remain calm when possible, she acknowledged that many arrive at the emergency department on one of the worst days of their lives.

“We need a major overhaul to our healthcare system,” Isbell said. “The emergency room is an incredible resource to society, but it’s not well funded.”