Asking your patient open-ended questions about how they're doing can lead to a much deeper conversation that not only illuminates the origin of their anger and suggests treatment strategies, but can also be therapeutic in itself.
What do you do when a patient (or parent of a patient) comes to a visit angry or irritated? It’s a challenge we all face as clinicians. I’ll share what works for me, as a psychiatrist who specializes in working with teens and young adults, and maybe these tips will be helpful for you, too.
1. Check in with how they’re doing.
“How are you doing?”
“How are thing going for you today?”
Perhaps they were stuck in traffic and worried they’d be late for the appointment, maybe they were yelled at by their boss, dismissed by their co-worker, or got into an argument with their spouse or child. Alternatively, perhaps it’s a more pervasive issue.
Once I ask a simple, open-ended question to check in and listen to whatever is going on with them, it generally diffuses the anger or irritability and sheds some light as to whether or not there’s a larger problem.
2. Follow up with further questions about how they’ve been since their last visit.
If there doesn’t seem to be an immediate cause for the anger or irritability, I follow up with more general questions about how they’ve been doing since the last visit.
I might express concern that they seem to be struggling or seem tense or stressed.
I ask if they have been taking care of themselves (or perhaps focusing all of their energy on taking caring of others).
I inquire about how they’re sleeping at night (specifically, difficulty falling asleep, staying asleep, or waking up earlier than the alarm goes off), which then opens a door to discuss the connection between irritability and poor sleep. Once we have established if there is poor sleep, I follow up with questions to figure out the cause of the poor sleep—difficulty settling down for bed due to anxiety or overstimulation, electronics interfering with sleep, or caffeine intake, to name a few.
I also like to ask about any issues with pain—the other day a teenage patient said, “Well, of course I’m irritable, I have headaches every day.” We talked about how frequent pain can contribute to irritability.
I’m also curious about stress level (home, work, school, relationships), which often leads to exploring how they’re managing stress and about worrying specifically. If the patient endorses anxious thoughts I delve deeper into the frequency, duration, and impairment associated with these symptoms, and discuss the link between anxiety and irritability.
Similarly, I ask about low, depressed, or apathetic mood, since irritability can be present as a symptom of depression. Are they feeling hopeless or having thoughts that they would be better off dead? Are they experiencing any changes in appetite or having trouble functioning at school or work?
Based on what I learn from the patient, I can know how best to help, whether it be offering a referral for therapy, discussing medication options, focusing on sleep hygiene tips and/or relaxation strategies, or recommending that they take some time for themselves.
Asking your patient open-ended questions about how they’re doing can lead to a much deeper conversation that not only illuminates the origin of their anger and suggests treatment strategies, but can also be therapeutic in itself.