ストレートな言葉で患者を怒らせる職員「私は正しいのになぜ?」の直し方

※ 日経ヘルスケア 2012年9月号 掲載 ブログにするにあたり株式会社日本経済新聞出版社より許可を頂いております。

ストレートな言葉で患者を怒らせる職員「私は正しいのになぜ?」の直し方

西日本のある診療所で受付業務を担当しているA子は、
思ったことをストレートに口にしてしまうタイプだ。
「さっぱりしていていい」と言ってくれる患者もいるが、
「あの言い方は何なの?」と、
患者や家族からクレームを受けることも多い。
先日も地声が大きい患者に対し、
「そんなに大声でなくても聞こえますから」と言い放ち、
その患者から怒られてしまった。

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A子は開業当初から勤務しているスタッフの一人だ。
レセプト処理など熟練を要する業務を素早くこなせるため、
他のスタッフからの信頼が厚く、
受付部門の責任者を任されている。

その一方で、患者応対については、
ストレートな物言いゆえに
「細やかな配慮が足りない」ととらえられることが多く、
患者の評判は必ずしも良くなかった。

A子が勤務する診療所は
内科、小児科、皮膚科を標榜しているため、
待合には小児患者が多く、
子ども絡みのトラブルがしばしば発生する。
最近も子どもが大声ではしゃいでいたとき、
A子は
「ほかの患者さんに迷惑なので、お子さんを静かにさせてください」
と強い口調で注意し、母親を激怒させてしまった。

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「どう言ったらいいんですか!」

院長はA子に、
「患者さんにもっと丁寧な言い方をしなさい」と指導したが、
「じゃあ、どう言ったらいいんですか!」と逆に問い詰められ、
答えに窮してしまった。
対応に苦慮した院長から相談を受け、
筆者はA子の指導に乗り出すことになった。

A子に対し、
あるべき患者応対の方法を個人指導する手もあったが、
筆者はあえて集合研修の形を取ることにした。
患者応対の上手な同僚の考え方を聞かせることで、
A子自身の「気づき」につなげる狙いがあったからだ。

そこで、
まず他のクリニックで実際に発生したクレーム事例を示し、
「なぜクレームになったのか」
「どんな対応が望ましいか」
について全員でディスカッションしてもらうことにした。

紹介したのは、乳児の母親から寄せられたクレームだ。
「待合にいるときに、隣に座っているお年寄りが子どもに執拗に話しかけたり触ってくるので迷惑している。何とかしてほしい」
というのが、その内容である。
「他の患者のお子さんを触らないでほしい」ということを
どんなふうに老人患者に伝えるか、1人ずつ発表してもらった。

「お子さんに触らないでくださいとストレートに言うのも、何だか角が立ちますよね」
「『感染症の心配がありますので、院内のお子さんには触れないでください』という張り紙を貼ったらどうでしょう」
など、スタッフから多くの意見が出た。

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「話す前に考える」習慣がなく…

活発な意見が飛び交う中、
A子はあっけに取られた様子で一言も発しなかった。
そこで筆者が、
「A子さん、意見でなくて感想でもいいですよ」と発言を促すと、
「相手に話す前に、どんなふうに伝えるかなんて、これまで一度も考えたことがなかったんです。みんな、話す前にいろいろと考えているんですね。勉強になります」
と答えた。

続いて筆者は、カウンセリングの世界でよく用いられる
「自己主張の3つのタイプ」の考え方を説明した。

3つのタイプとは、
「アグレッシブ」(攻撃的)、
「ノンアサーティブ」(非自己主張的)、
「アサーティブ」(建設的)を指す。
子どもに触れたがる老人患者を目にして、
「何とかしなくちゃ」と思いつつ何も言えないのは、
「ノンアサーティブ」な対応だ。
反対に、「お子さんに触らないでください!」などと
強すぎる言い方をするのは「アグレッシブ」な対応である。

また、
「赤ちゃんは免疫が弱く感染症にかかりやすいので、ご家族以外はむやみに触れないようにお願いします」
という張り紙を指差しながら、
「申し訳ありませんがご協力をお願いいたします」と伝えるなど、
ソフトだが必要な内容をきちんと伝えることが
「アサーティブ」な対応である。

この分類に当てはめると、
A子の自己主張は「アグレッシブ」そのものだ。
「アサーティブ」な対応を取ることの大切さを
知ってもらう必要があった。

そこで、筆者は次に、
「何度言っても診察券を忘れてくる患者にどう注意するか」
「保険証を忘れてきた患者に10割分の治療費を支払ってもらうときに何と言うか」
「予約なしで予防接種を受けに来た患者をどう断るか」
など、具体的なシーンを設定。
「アグレッシブ」「ノンアサーティブ」「アサーティブ」の
各パターンではどんな答え方になるのか、
一人ずつ発表してもらった。

A子は3パターンの表現をしながら
「ああ、私ってアグレッシブな表現ばかりだったんですね」と発言。
普段の自分の応対をしきりに反省していた。

*******************************************************

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************************************************

「性格がきつい」と決めつける前に

研修後にA子に話を聞いたところ、
彼女の父親は建設業を営んでおり、
兄弟構成は兄、弟とA子の3人だという。
A子が思ったことをそのまま口にしてしまうのは、
オブラートに包まずに本音をぶつける父親や男兄弟と
一緒に暮らしていたことが影響していると思われた。

A子はこれまでも、正しいと思って言っただけなのに、
なぜクレームを言われるのか分からないことが多々あったという。
だが今回の研修で、
自分が「アグレッシブ」な言い方しかしておらず、
そのせいで患者とうまくいかなかったことに初めて気づいた。

A子のようなタイプの人に対して、
職場の管理職や同僚は、ともすれば
「心がない」「性格がきつい」というレッテルを貼りがちだ。
だが実際には、本人に悪気はなく、
ストレートな物言いがなぜ問題になるのかを単に理解できていないことも多い。

そうしたケースでは、
本人に口頭で注意するという通り一遍の指導では解決しないことがほとんどだ。
今回紹介したように、
具体的なケースを想定してスタッフ同士でディスカッションしてもらい、
本人に自分の対応を洞察させることは効果的な手段となる。
ぜひ参考にしていただければと思う。

 

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・技術チェックを受ける際、学生が自分で患者選定ができない
・バイタルサインが異常値でも、すぐ報告に来ない
・患者さんと仲良くなると言葉使いが敬語ではなくなる
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