By Cheree Cleghorn, Editor

A super-star super-specialist blew up at a patient.

This man rarely is speechless. He was that day.

Patients who have to face challenging treatment beg friends and family members who are working with their caregivers, “Please don’t make the doctor mad.”

When his wife called his internist to tell him about it and get his advice, the doctor said, “As a physician, I find this painful to hear.”

There are few words harder for conscientious, caring doctors to hear than those that tell them that a patient is afraid of making them mad. Fear does not a good patient-doctor relationship make.

While the public opinion polls show high levels of patient satisfaction with their health care generally, these studies cannot capture those moments of true fear—-when a patient must count on a doctor’s skill and, yes, concern, to get through the treatment. If there is any evidence of anger, the patient feels even more vulnerable.

This writer has had talks with patients ranging in age from their 20s up to their 90s for more than 25 years.

People of all ages have asked, “What if the doctor gets mad?”

They have asked about many other things, too, that have to do with the job of being a patient. Getting second opinions. Making treatment decisions. Dealing with how they feel about their diagnosis.

However, a steady number of calls come because, ”I don’t want the doctor to get mad at me.”

Patients who have to face challenging treatment beg friends and family members who are working with their caregivers, “Please don’t make the doctor mad.” They have called to get information about how to prevent that.

No new technology, medication, research study or method of providing care can ever erase the very human fear that a caregiver will become angry or indifferent.

An example: A sobbing friend called, saying, ”Let me tell you what he said!…. I don’t ever want to go back there! …. Now what do I do?”

The question people ask most often is, “How do I tell the doctor that…” Usually the caller-patient has wanted to find out how to ask the question to get a clear answer or how to broach a complicated subject.

At other times, though, the caller was apprehensive about the doctor’s disapproval. They are worried about how the doctor will judge their health behavior or their problem. This is a verbal cousin to the fear of making the doctor mad.

When patients go to doctors, hoping this is the one who might spare them pain, deliver a cure or, at least, make the problem more manageable, the fear factor should never be discounted. The more important the outcome is to the patient, the more important it is that the patient feels safe with the physician.

What can patients do when they sense the doctor is angry? Or, worse, when the doctor has been clearly angry at them?

How To Know When The Doctor Isn’t Mad

First, it helps to know what mad is not in the world of doctors.Doctors can get frustrated with patients who don’t take essential medicines or follow a treatment plan the two of them agreed on. That frustration may show. That’s not mad. That’s worry about the consequence of missed medicines or a screwed-up treatment plan on the patient’s life.

A doctor whose patient is a long-time friend may say, “What am I going to do with you? You have got to stop smoking. You’re a mess.” That’s not mad. That’s deep concern.

A doctor who is treating a patient whose behavior is putting himself at high risk can get very, very firm. That’s not mad. That is stating the risks in blunt language, words blunt enough they may get through and prevent a premature death or personal tragedy.

When A Doctor Really Does Get Mad

Doctors who raise their voices to patients, unless they are hard of hearing, likely are mad. Eyes can flash. Jaws may clinch. Body language tells you how mad the doctor may be. Body language rarely misleads us, although its messages may not be 100 percent accurate. Doctors who make no effort to conceal their anger to the patient, and to anyone accompanying the patient, are the real-deal mad. An example: A patient asked three times for an answer to a legitimate question during a visit. The doctor ignored the question twice. When the patient asked the question for the third time, the doctor responded angrily, “I don’t want to deal with this today!” and left, slamming the door behind him.

Then there are famous doctors whose practices are focused on the sickest patients in one specialty. “This is a waste of my time!” Imperious super-specialist doctors (and many, many are not like that) can blow up at what they may perceive as the waste of their time because the patient’s problem is not “serious” enough to warrant an appointment.

To the patient, it can feel like one of the best doctors in that field is mad at him personally.

The real problem is between Dr. Imperious and the referring physician, but the patient is caught in the middle between them. A most uncomfortable place to be.

Then there are doctors who give patients ultimatums.

“Either you do it my way or you find another doctor! I will not tolerate interference!” Patients who say they would like to get a second opinion can be literally scared out of getting one by angry responses like that when they ask. Now that second, or third and fourth, opinions are common because treatment options are complex, this request should not feel like an insult to any doctor. However, second opinion is a term with a lot of electricity in it.

Finally, there is another issue akin to doctor’s being mad at you. It is being mad about the problem. For instance, smoking makes them so furious they may use demeaning language. “How could you be so stupid as to keep smoking?”

That anger is the doctor’s problem, not the patient’s. No patient should be cared for by a physician who cannot have empathy for the problem, even though it is a serious one that still needs attention.

That kind of demeaning talk is a sure sign the patient needs to get another physician.

We all have bad days.

However, as noted above, the balance of power between doctor and patient is weighted heavily on the doctor’s side at all times. This kind of medical mad is not right nor fair.

What Can You Do?

This response should work in most situations when you think the doctor is getting mad—-no matter whether you avoid confrontations generally in other parts of your life or not.

This should be a one-response-fits-all solution. Please memorize it. You never know when you may be surprised by wrath in a white coat.

“I seem to be communicating poorly today. I think it best to end this visit now. I will reschedule so we can start over. Thank you for your time.”

Why will it work?

The use of “I” rather than “you” is the key.

You are putting yourself in the position of making a calm exit with all of your options protected.

You can go back to this doctor if you choose.

You can find another one if you choose.

In either case, you have time to think about what you want to do.

Ask For Your Primary Care Physician’s Advice

This is another example of why a good working relationship with your primary care physician is so important. If your regular doctor referred you to this angry clinician, call your doctor and report what happened so you can get advice about what to do next.

You and your doctor can decide whether you think you want to try this doctor one more time or you want a different doctor. If you do, your own doctor can help with that.

Primary care physicians usually have a good sense of what patients will do well with certain doctors.

Patients have many concerns.

One of them should not be worrying needlessly about making the doctor mad.