November 13, 2025
3 min read
Key takeaways:
- Many dermatologists will encounter an anxious or angry patient at some point during their career.
- Using thoughtful words and actions can aid in the de-escalation these situations.
CHICAGO — Calming angry or anxious patients who need dermatologic surgery requires carefully selected words and actions, according to a speaker.
Having a patient with escalation tendencies is something that most dermatologists will experience during their career, Nahid Y. Vidal, MD, FAAD, FACMS, division chair and associate professor at the Mayo Clinic in Rochester, Minn., said during a presentation at the American Society for Dermatologic Surgery annual meeting. Yet, the art of de-escalation is a tactic in which dermatologists have received limited training.
“I was lucky enough to take a voluntary class in medical school on de-escalation training called ‘Healer’s Heart,’” Vidal said. “Best decision I ever made. It has rescued me in so many situations.”
Often, escalation tendencies can be linked with past trauma where the patient felt powerless and unheard, leading to emotional dysregulation, Vidal said. Although a patient may or may not have regulation issues in general, it is important to understand the underlying cause of his or her anxiety when attempting to de-escalate.
“A lot of times when they’re feeling anxious or they have feelings about medical care in general, it started long before they met you,” Vidal said. “It may feel very personal, but it’s not.”
Vidal shared the de-escalation techniques that she employs at her practice. There are multiple approaches providers can use, the first being using soothing micro-phrases, which include:
- “Take your time.”
- “Tell me more.”
- “How does that sound to you?”
- “I know it was frustrating that…”
- “Let’s see what we can do today.”
- “You are in control of your body. If you want us to stop, we will stop.”
- “That’s a good point — let’s build on that.”
- “Despite how hard this is, you’re going to get through it and we thank you for trusting us with that.”
- “What would make this easier for you?”
- “Let’s figure this out together.”
These comments can help a patient feel autonomous, respected and validated while also allowing providers to channel the patient’s focus, collaboration and forward movement during a surgical appointment or procedure, according to Vidal.
In addition to micro-phrases, providers can also engage in micro-actions to calm escalated patients. These include:
- Pausing before you enter a room;
- taking three deep breaths to focus on the physiological relaxation of your own body, as your feelings can affect your patient’s emotions;
- using the tongue to roof-of-mouth technique, which acts as a self-distractor in case you are also feeling emotional while attempting de-escalation;
- validating and praising the care team without labeling the patient as difficult;
- practicing self-awareness, including “name-it-to-tame-it” thoughts;
- having an open posture, which is defined as standing at a 45-degree angle when facing the patient, making sure your hands are visible and maintaining that open posture; and
- setting boundaries if necessary.
“This all matters because [anxiety] is a barrier to care,” Vidal said. “Overall, the most general rules of thumb to keep in mind are that the more escalated a patient, the more you have to remain calm, have a positive mindset and be completely nonjudgmental in the words you use as well as the tone.”
Vidal emphasized sympathy as the most vital asset when de-escalating a patient.
“Patient don’t hear anything you say until they feel that you care,” Vidal said. “This is even more important for the patient who is elevated. They are not going to remember a lot of the details, but they will absolutely remember how you made them feel.”
Sources/Disclosures
Source:
Vidal NY. The anxious patient in dermatologic surgery: Art of de-escalation. Presented at: American Society for Dermatologic Surgery annual meeting; Nov. 13-16, 2025; Chicago.
Disclosures:
Healio could not confirm Vidal’s disclosures at the time of publication.
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