Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Time out 


When emotions run high in clinical situations, it can be helpful for everyone to take a break and come back together when feelings have cooled down.

My 92-year-old patient’s daughter-in-law was very angry. She pulled me to the side of the hospital hallway and raised her voice. “Why did you order the CT?! She just needs her symptoms treated and doesn’t need that!”


I felt overwhelmed and confused.  The CT had been entered by a different clinician when she’d been admitted. I’d just taken over her care that morning, and after talking to the patient’s son at the bedside and confirming goals of care, I had canceled that order. The patient didn’t get the CT. What did I do wrong? Why was she so angry at me? When I finally went back to the workroom, I broke out in tears. I felt shocked and upset.


In the past decade, I encountered countless family members who were upset. Most of the time, I could relate to their anger and conveyed my empathy. But there were times when that felt challenging. I’ve thought about how we clinicians can better handle such situations and have learned several things.  


1. Imagine reasons why the patient or family might be upset.  

Their loved one is sick and in the hospital. They’re likely scared. They might have had a rough day. They might have had similar events before and been traumatized from that experience. Whatever the reason is, it’s not about me and I shouldn’t take it personally. 


2. Remember that when any of us is angry, we are often irrational. 


3. Take a time out.  

Acknowledge the feelings of both sides and propose a break. Returning later to talk more can be an effective way to decompress charged emotions on both sides. 


4. Debrief challenging experiences with someone you trust. 

For example, my hospitalist group has a regular walk-in session called DASH (Debriefing And Supporting Hospitalists) as a venue to share our challenging encounters guided by health psychologists. 









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.