Anger hurts your team’s performance and health, and yours too

Anger hurts your team’s performance and health, and yours too | Image Credit: © tuaindeed - © tuaindeed - stock.adobe.com.

Anger is generally defined as a negative emotion. Although anger can be used productively and can initiate positive results, especially when justified, the negative consequences, in behavior and physiologic effect, outweigh any benefit of this emotion. Although many formal definitions of anger exist, words such as antagonism, belligerence, and displeasure dominate the descriptions.

Centuries ago, the Roman philosopher Seneca penned perhaps one of the most stirring descriptions of this emotion: “the most hideous and frenzied of all the emotions, a ‘brief insanity’ during which we are closer to a wild animal than a civilized person.”¹ The response to anger is to remove the source or sources that provoke this negative emotion. The strategy of removal and the physiologic and psychological effect of these emotions before removal or resolution defines the consequences, in our case to our teammates in health care, our patients, and ourselves. Before we delve into causes, effects, and mitigation, let us look at the scope of the problem.

Anger is increasing

It is not that anger is new to our country. In 2022, The New York Times published a series of articles under the heading “The Year We Lost It.”² One article acknowledges effective positive rage, such as during the “years of hope and days of rage,” of the 60s, but 2022 was when Will Smith acted on his negative rage by slapping Chris Rock in front of millions of viewers on live television––hardly a positive or effective experience for either performer. We can quantify the increase in these observed activities in the health care setting. From 2011 to 2018, violent attacks against medical professionals increased by 63%, and this was before the COVID-19 pandemic, an event well known to have increased aggression against health care workers. In a 2022 survey of members of the nation’s largest union of registered nurses, 48% reported an increase in workplace violence.³

Anger is not good for your health

Anger has a profound effect on the neurohormonal system, causing a multitude of negative physiologic responses and consequences.⁴ In addition to the impact on the heart’s conduction system, the anger-induced immune-mediated release of inflammatory cells can lead to the rupturing of coronary artery plaques, leading to infarction. Increased adrenaline output mediated by anger can lead to gastrointestinal tract hypermobility, loss of appetite, and malabsorption. The effect of anger on the brain is more complicated. Anger can be considered an adaptive response. In that regard, our brains can be primed for action, leading not only to motivation but to a critical fight-or-flight response to a perceived dangerous situation. On the other side, however, anger can negatively affect our judgment and block out other effective adaptive signals. Anger also mediates a host of negative consequences due to its effect on sleep.

Health care workers are angry

In addition to workplace violence, a consequence of anger towardhealth care workers, health care professionals themselves are experiencing internal anger. Although the pandemic may have brought attention to the issue of health care workers’ anger, it certainly is not the only factor. The pandemic allowed workers to express their anger openly, whereas previously such expression was considered unprofessional. But even before this new expression of anger, it would have been naive to suppose that health care professionals did not experience anger similarly to others in professions with less frustrating and stressful positions.⁵ Although the situation surrounding the pandemic identified unique factors that instigated anger among health care workers, such as perceived systemic failures and increased clinical loads related to the lack of use of effective preventive and therapeutic interventions, the decrease in clinical burden of COVID-19 has not removed the anger associated with the health care profession. Two themes are felt to contribute to anger: feeling overloaded and overwhelmed and feeling a lack of control over the work environment. The anger over vulnerability to infection experienced during the pandemic could now translate into anger due to concern about safety from workplace violence. But it is not only anger-induced violence that threatens the health of health care workers. As we mentioned previously, the anger itself can be harmful.

Patients are angry

Patients can become angry for many reasons. Identifying the root cause of the anger is the foundation behind strategies (which we discuss later) that mitigate the risk of that behavior to both the health outcome of the patient and the safety of the health care team. The reasons for anger can be placed into 3 buckets:

• The disease itself. Although the etiology of pathology may often be related to personal habits, patients may be angry due to the perceived unfairness of a diagnosis such as cancer or autoimmune disorder and its impact on happiness or lifestyle. Many diseases are accompanied by physical pain and suffering, which can be a physiologic trigger for anger.
• The health care system. Patients often face the obstacle of navigating a complex system to access the necessary health care. They face barriers such as a lack of resources and preauthorizations. When that already frustrated patient faces an unanticipated long wait for a rushed visit, anger is likely.
• Poor diagnosis or treatment outcome. Health care is complex and imperfect. If a patient who is already vulnerable due to their disease state does not obtain the outcome they expect, anger and its consequences may follow.

Managing the angry patient

Remembering that much anger is triggered by a perceived unfair diagnosis, we can find great lessons in de-escalation techniques revealed in the oncology literature.⁶ Before addressing the patient and their anger, make sure you are in the right frame of mind by being aware of your own stress levels, which could lead to the unintended escalation of an already volatile situation. Show the patient respect. This is among patients’ most often mentioned expectations, and a perceived lack of respect may further inflame an angry patient. Make sure you are not only listening but that the patient perceives you are listening. This is especially difficult in an era when the health record is on a computer screen, which may make you seem distracted.

Your listening must be intentional. Acknowledge the patient’s anger and take responsibility for the flaws in care. This does not mean you should disclose a medical error, but you should certainly apologize for any delay in care, even if it was not your fault. Do what you can to resolve the situation. Practice service recovery if necessary. Most importantly, if you feel the situation is becoming threatening, remove yourself from the environment and get help.

Manage your anger

Failure to manage your anger can negatively affect your ability to provide care or ascend to a leadership position in your health care system. And, as previously mentioned, it is just not good for you. Fortunately, there is no shortage of anger management techniques, including these 5 strategies⁷:

1. Understand your triggers. This will allow you to avoid situations that may trigger anger in the future. Journaling, a technique mentioned in many other self-improvement strategies, may help.
2. Develop coping mechanisms. If this article has revealed anger as an issue for you, research this area. One mechanism is box breathing, where you hold your breath briefly between deep breaths until calm returns.
3. Reframe your thoughts. Replace negative beliefs with positive statements. Realize you may not be able to control what angers you, but you can control your response.
4. Find solutions rather than vent excessively.
5. Prioritize self-care. Being a health care professional in a clinical or leadership role is stressful. Look for support groups, even informal ones, who can empathize. Invest in your physical well-being. You deserve it.

Remember, anger is not always destructive and cannot be avoided. The key is to manage it, mitigate its risk, and exploit its advantages of self-protection and increased productivity.

References:

1. Watt Smith T. Anger. Psychological Science. 2016. Accessed August 24, 2024. https://psychologic.science/general/emotions/5.html
2. The year we lost it. New York Times. 2022. Accessed August 24, 2024. https://www.nytimes.com/interactive/2022/12/17/style/2022-year-of-rage.html
3. Boyle P. Threats against health care workers are rising. Here’s how hospitals are protecting their staffs. AAMC. August 18, 2022. Accessed August 24, 2024. https://www.aamc.org/news/threats-against-health-care-workers-are-rising-heres-how-hospitals-are-protecting-their-staffs
4. Gorman JM, Reist C. Anger among health care professionals. Psychiatric Times. April 7, 2022. Accessed August 24, 2024. https://www.psychiatrictimes.com/view/anger-among-health-care-professionals
5. Cherelus G. How anger affects the body. New York Times. December 17, 2022. Accessed August 24, 2024. https://www.nytimes.com/2022/12/17/style/anger-body-health-effects.htm
6. Wolf K. Cooling down the clinic: how to de-escalate angry patients and family members. Oncology Nurse Advisor. May 17, 2024. Accessed August 28, 2024. https://www.oncologynurseadvisor.com/features/how-to-deescalate-angry-cancer-patients-family-resolution-treatment-risk/
7. Castrillon C. 5 healthy ways to manage your anger at work. Forbes. July 30, 2024. Accessed August 24, 2024. https://www.forbes.com/sites/carolinecastrillon/2024/06/30/5-healthy-ways-to-manage-your-anger-at-work/