Managing an aggressive patient

Dec 14, 2016

Issues of health can elicit very strong emotions. It is therefore likely that you will be subjected to a highly distressed patient or relative at some stage in your career, so it pays to know how to handle them to prevent the situation from escalating.

You may be in a practice or a hospital situation where there may be clear messages about what patient behaviour is unacceptable. Unfortunately this won’t stop a person who has tipped over into an emotional state because they won’t be responsive to rational reasoning.

This person will be operating from a point of emotional angst and this is what has to be addressed. To get a successful outcome, the patient or their representative needs to feel they have been heard and their concern taken seriously. They may also be in a lot of physical pain, or a high state of fear or panic, so will want reassurance that they will get the treatment they need.

Sometimes their relatives will act aggressively out of concern for their loved one and will calm down when they know they will get treatment or once the treatment has actually started. So wherever possible, begin by taking initial notes as this effectively starts the treatment process from the patient’s point of view.

Be alert to early warning signs

If a patient or their relative displays behaviours such as a demanding tone, prolonged staring, an intense gaze, raised voice or impatience, this person most likely will need extra care and attention. It is a fine balance between being empathetic to them and maintaining a strong boundary to protect yourself. You have to reach out to them in some way and this starts with acknowledging them. You might offer them a seat if they need one or a glass of water. That can immediately make them feel welcome.

If a patient is angry, it is best to allow them to vent. Acknowledge their anger with a statement such as ‘I can see that you are very upset about this’ and validate their feelings with a statement such as ‘Understandably you are angry, this is a very frustrating situation you are in.’

Avoid outwardly or inadvertently telling someone that their reaction is not appropriate. If you are able to maintain a calm and neutral tone and adopt an attitude of intent to learn about their point of view it will diffuse the tension. You don’t have to agree with the patient’s point of view or take it personally, it is simply their opinion.

If the person is standing close to you, take a small step away. This achieves two things – firstly it gives the patient more space and secondly, it protects you. Taking this stance will allow you physical and emotional space so you can keep an open body posture and listen to what they are saying. You are also less likely to become judgemental or critical and defensive as you won’t feel so closely threatened in a physical sense.

Ideally there should be someone else around when you are dealing with an aggressive person so call on support from someone else working with you. If it does look like it is escalating, you should notify security or the police. Your safety and that of your clinical team is a priority.
Should you find yourself alone in a consulting room in this situation, it is good practice to always leave the door open and sit where you are in direct line of the exit door, that way you are in control and can get out quickly if need be.

Take action and keep the patient notified

Wherever possible, keep the patient informed of what is happening now and what the next steps will be, along with any estimates of time. This information can help an anxious or angry person to calm down as they know that a resolution to their problem is on the way.

Learn more

Visit the Avant Learning Centre for resources on dealing with difficult patients.

The RACGP has a detailed handbook on safe practice.

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