Keeping calm: how to manage confronting situations

It’s common for frontline staff in any organisation, including medical practices to feel the wrath of the public they serve.

If your practice has increased fees or transitioned from bulk-billing to private billing, patients may express anger or frustration. For some patients who are not used to paying out-of-pocket or cannot afford the new fees, their aggression towards you or your staff may be heightened.

All staff should be prepared to deal with angry patients. They must be supported and trained, and strategies have to be in place to manage the psychosocial impact on staff.

Know how to respond

The risk of aggressive patient behaviour should be considered as part of your practice’s risk management strategy.

The best way to respond to unreasonable or aggressive patient behaviour is to have a plan in place so staff know what to do when it occurs. Your plan could include a script for staff when the aggression erupts, then tips for how to escalate the matter to the practice manager or elsewhere.

It may help to role play- and rehearse multiple times so staff can respond appropriately, even when they feel stressed and threatened.

Prepare people for change

Often patients become aggressive because they are surprised by the change. Prepare everyone involved for any changes, including patients, practitioners and the support team. Discuss a lead time for these changes that affect patients and create a communication plan.

Set boundaries

The practice team must work collaboratively and follow the same rules. A consistent approach helps patients understand boundaries and manage or de-escalate future difficult encounters. A complaints policy will allow patients to voice their grievances and know they are heard. 

Always make sure you and your staff are safe and recognise some are more vulnerable than others. Regular debriefings and consultations on managing angry patients are essential. While practices often report physical violence, they are more likely to report patient aggression, threats or complaints. 

If an encounter is violent, staff should try to stay calm, avoid inflaming the situation and get help or retreat to a safe place if necessary. A tested safety policy should be in place that all staff are familiar with, and regularly reviewed and updated. It is also good to have an expected behaviour policy in place because it lets the team know their wellbeing is a priority. Ideally, the policy should reflect the behaviours that staff and patients will demonstrate to each other.

Try listening

It’s a normal human response to want to defend ourselves against aggression or unreasonable behaviour. However, it’s best to try and listen and not take it personally or start responding defensively. Giving the patient a chance to have their say may be enough to diffuse the situation if it does not risk the psychosocial health of a staff member. 

Acknowledging someone's experience and expressing empathy can be very powerful. Even if you are not responsible for the situation, you can say you are sorry they had that experience and acknowledge their feelings - this is not an acknowledgment of legal responsibility, but another step that may reduce the temperature of the encounter.

Avoid being manipulated

Be careful not to compromise patient care by giving in to demands you feel are unreasonable. A patient may, for example, threaten to make a complaint or take legal action if you refuse to see them for free. These patients may believe they are entitled to this, and you are unlikely to be able to persuade them otherwise.

Having clear boundaries or practice guidelines can help with a consistent message to patients about what is reasonable. Try to assist the patient within acceptable boundaries but be prepared to say no and seek help from a colleague if necessary.

If you compromise with the patient, make sure you explain it is a ‘one-off’ and make a note in their medical record.

Know your limits

Being under stress ourselves may make us more likely to react in a way that escalates a situation. Taking a few breaths and observing your reactions can help with the delivery of your response. Also, be aware of your body language and tone of voice – try to keep calm, use a neutral tone and adopt an open body posture.

If you can’t respond effectively, someone else may be better off dealing with the situation. They may be more experienced, have a better relationship with the patient, not be triggered by the patient’s responses, or simply having a better day. 

Ending a patient relationship 

Doctors are not obliged to continue the care of a patient where they hold genuine concerns about their safety or the safety of staff. However, you must consider any care required by the patient and a doctor's obligation not to refuse care in an emergency.

Be confident the steps taken by the doctors and the practice are reasonable in the circumstances. Contact your medical indemnity insurer for advice before ending a treating relationship or counsel a staff member on how they have managed a situation.

Document any confronting situations, including in the patient record, but make sure these are factual and objective because the patient may read them. You may also need to put a detailed incident report in the practice records, separate from the patient’s clinical notes.

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