Keep your cool: how to handle aggressive patients

Jan 20, 2017

A patient smells of alcohol and is unsteady on his feet. He glares at you and yells abuse at a passing nurse. You walk past him to assist another patient, when he suddenly takes a swipe at you. What should you do?

The odds are that at some point in your career as a doctor you will be hit, sworn at, shoved, spat on or kicked. There should be zero tolerance for this type of behaviour, but unfortunately it exists and flourishes in hospitals across Australia.

A national study of workplace aggression in Australian clinical medical practice concluded that workplace aggression is inherent in clinical practice.1

Overall, 70.6% of medical practitioners surveyed experienced verbal or written aggression and 32.3% experienced physical aggression from one or more sources in the previous 12 months.

The study also showed that more female doctors, international medical graduates and hospital-based clinicians experienced workplace aggression.

“Younger doctors were most likely to face patient aggression due to their long working hours and lack of experience in dealing with tense situations,” the authors concluded.1

Pick up the clues

There are a range of patient behaviours you should look out for, which can be early predictors of violence. These ‘red flags’ can include name calling, swearing and prolonged or intense glaring.

Initially, simple steps such as offering the patient a drink, food or a place to sit, as well as talking to the patient’s family and friends to gain support, can prevent the situation from escalating.

De-escalating aggressive behaviours

Addressing aggressive behaviour can be difficult, but there are some useful strategies which can calm hostile situations down. It is a good idea to practice ways of de-escalating the situation with other colleagues, so that you are prepared for a situation if it arises and know what works.

The best approach is to ascertain how the patient is feeling and what they want. Remain calm and use phrases such as “I can understand how you feel” to diffuse the situation. Listen to the patient, then try and discuss solutions with them.2

Tricks of the trade


  • Speak softly and refrain from exhibiting a judgemental attitude.
  • Try to remain neutral, although it may be difficult with an irrational patient.
  • Put some distance between yourself and the patient, and do not make intense eye contact.
  • You should try to demonstrate control of the situation, without becoming demanding or authoritative.
  • You should seek to smooth the situation over, rather than bully the patient into better behaviour.2

It is highly likely that you will face an aggressive patient at some stage in your career, so practise how to deal with these types of situations now so you do not lose your cool.

Remember, that you are not on your own and work as part of a team. So, if you feel that you are in danger, it is important to seek help either by calling hospital security or the police.

Learn more on this topic

The Avant Learning Centre has an eLearning course Managing difficult patients and webinar Demands, expectation and complaints: managing difficult patients to further develop your expertise in this area.

References


  1. Danny J Hills, Med J Aust 2012; 197 (6):336/340
  2. www.ausmed.com.au Mar 24 2014

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