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MRCPsych CASC: Emergency Assessment of an Angry or Anxious Patient or Relative

CASC Notes: Emergency Assessment of an Angry or Anxious Patient or Relative

As you enter the station, it is important to show your badge to the examiner and nod while saying a quiet "Thanks". When you meet the relative or patient, they may be standing up, so it's best to start by taking a seat yourself. You can say, "Hello, my name is Dr Waleed. Thank you so much for agreeing to see me today. Do you mind if I take a seat?"

Starting with a calm and friendly approach is crucial in building rapport with the patient or relative. You can say, "First of all, thank you so much for coming to see me today. Good communication between patients or relatives and the psychiatry team is very important to us, and we value it greatly."

You can also express your empathy and acknowledge their difficult situation by saying, "I can't imagine how difficult it must be as a mother/father/sister/carer to see your loved one suffering like this."

If the relative or patient is angry with another staff member for not caring or communicating, you can assure them that you will address the issue immediately. You can say, "I will talk with that member of staff straight after" or "Thank you for telling me. It is really important that we know this. We will look into it as soon as possible."

In case the patient or relative mentions side effects of medications, you can inform them that you have an official complaints procedure they can follow if they wish to take the matter further.

If the patient or relative says they are leaving, it's important not to block the exit, but you can try to calm them down and offer help by saying, "I can see that you're really anxious. Perhaps we could sit down and talk about it. I'm here to help. You're in a safe place now."

If the patient or relative says they are not mad, you can respond by saying, "I'm absolutely not suggesting you are mad, but I can see that you are suffering, and I'm here to help. It must be very distressing for you. Perhaps we can sit down and talk about it."

If the patient or relative asks to be removed from the section, you can explain the process and say, "I do understand your concerns, but the decision to remove the section is not just up to me. It's a team decision. I can assure you that as soon as the team feels that you no longer need to be on a section, it will be lifted. Have you been told how you can appeal against the section?"

If the patient or relative asks to speak to a male or female doctor, you can apologize for the unavailability of the preferred gender and ask if a nurse of the preferred gender can be present. You can also ask the reason for their discomfort and continue the interview by saying, "You seem quite distressed at the moment. Could I ask what's been troubling you?"

To increase empathy, it's important to lower the tone and volume of your voice and make eye contact with the patient or relative. This makes you sound more convincing. When wrapping up the station, it's best to come up with a short and concise summary of the important issues discussed and offer support and resources, such as psychology, carer's assessment, occupational therapy, and medication options. Don't forget to thank the patient or relative for talking to you.

Look at the examiner and nod while saying a quick "Thanks".


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