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.
also showed that more female doctors, international medical graduates and
hospital-based clinicians experienced workplace aggression.
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
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
De-escalating aggressive behaviours
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.
some distance between yourself and the patient, and do not make intense eye
- 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.
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.
- Danny J Hills, Med J Aust 2012; 197
- www.ausmed.com.au Mar 24 2014
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