While most patients are extremely appreciative of the healthcare they receive, there are a few who express anger or hostility. This increased during the COVID-19 pandemic as the restrictions and regulations added stress.
Members often call our Medico-legal Advisory Service to discuss how to manage patient anger and aggression. When not dealt with appropriately, this can potentially become a staff safety concern. It may also result in the patient criticizing the doctor or the doctor’s practice on social media, or even making a formal complaint.
Patient aggression is also a work health and safety issue. Employers have a legal obligation to take all reasonable steps to eliminate or minimize work health and safety risks in the workplace, including those associated with patient aggression. These issues can be difficult to address but handling the situation well can avoid escalating conflict.
The following strategies can be implemented to reduce and manage instances of patient aggression.
Strategy #1: Ensure Staff Is Protected
Put up signs reminding patients that there is a zero tolerance towards aggressive and bullying behaviors. Ensure all staff have a safe exit strategy if faced with an aggressive patient.
Review and update the practice’s patient behavior policy to provide a reference for reception staff, practice managers, or clinicians. Where necessary, provide an employment assistance program to support staff.
Strategy #2: Understand the Reasons for Patient Aggression
Patients and their family members who are aggressive may be acting out of fear or ignorance. Rather than being judgmental of their behavior, seek to understand their motives. It’s likely the patient and/or their family aren’t aware of the challenges practices face, so objectively assess whether the issue is with the provider, the system, or them. Their anger may be normal and justified, as the health system can be extremely frustrating for patients.
De-escalation techniques include talking in a calm, quiet voice, not being threatening, having open body language, and being empathetic. The last thing needed is becoming angry, though that is easier said than done and is a skill that takes conscious effort.
Even if a patient’s behavior is unacceptable, take the time to listen. It’s not a good idea to cut them off without explanation or acknowledging their concerns. Obviously, it is a difficult balancing exercise, but try to resist refusing to engage with the patient, as this can inflame the situation rather than defuse it.
Consider the severity of aggression as a continuum, looking out for the early warning signs such as verbal aggression, heightened stare, body posture, and tensing of the hands into fists.
Strategy #3: Formulate a Clear and Concise Response
Staff should feel empowered to make it clear to aggressive patients that their behavior is unacceptable. Run training and role-playing with staff. This may involve practicing responding to a difficult situation by explaining why it occurred and apologizing for the inconvenience.
In extreme situations, staff should look after their own safety first, and call security or the police for assistance.
A Win-Win
Developing a strategy to prevent and reduce patient anger will help both minimize patient frustration and reduce the risk of receiving complaints, and ultimately be a win for everyone.