A hurried, impatient patient in athletic clothing with a history of atrial fibrillation wants his treatment completed as quickly as possible. All of the following are appropriate management strategies EXCEPT:

Correct answer: B. Confronting the patient about his impatience and demanding behaviour

• A. Clear, thorough EXPLANATION reduces anxiety and gives the patient a sense of control, which is particularly valuable for a person accustomed to being in charge of his own schedule.
• B. CORRECT — this is the EXCEPTION. CONFRONTATION is never an appropriate management strategy. It escalates the interaction, damages the therapeutic relationship, and in a patient with cardiovascular disease the resulting stress response — catecholamine surge, rise in blood pressure and heart rate — carries genuine physiological risk, including precipitating a rapid ventricular response in atrial fibrillation. The correct approach is calm, structured stress reduction.
• C. SHORT APPOINTMENTS are a core element of the stress-reduction protocol for cardiac patients and suit an impatient personality style. Morning appointments are typically preferred.
• D. Adequate ANALGESIA planning is appropriate: unrelieved post-operative pain is itself a stressor with cardiovascular consequences.

Note: Practical points for an atrial fibrillation patient: confirm anticoagulation status and obtain a current INR if on warfarin, limit epinephrine to about 0.04 mg (roughly two cartridges of 1:100,000), avoid retraction cord impregnated with epinephrine, and use effective local anesthesia because pain-driven ENDOGENOUS catecholamine release far exceeds anything in the cartridge.