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*If the patient is yelling or threatening, inform the patient that you are leaving the room and will return when s/he is calmer.
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Steps to recognize and manage angry and disruptive patients
Question clinique
How should clinicians manage angry and disruptive patients?
L’Essentiel
To recognize and manage the angry patient, the authors of this commentary encourage prior planning and a calm demeanor. The commentary has several recommendations on what to do and what not do. 5
Référence
Plan de l'etude: Other
Financement: Self-funded or unfunded
Cadre: Outpatient (any)
Sommaire
This POEM is a departure from our usual: The original article is not research but provides action steps we can use in our offices. Patients often present signs of increased anxiety prior to verbal and physical aggression. Being able to recognize these signs may help identify situations that can be de-escalated prior to further aggression. Given how common interactions with angry patients are in health care, it is recommended to not only come up with an action plan on how to respond to these situations, but also to rehearse these scenarios ahead of time. The following de-escalation techniques are useful components of this type of plan.
| Do Not | Do |
|---|---|
| Crowd or touch the patient | Give the patient your full attention |
| Let the patient get between you and the door | Stay composed |
| Interrupt the patient | Actively listen |
| Yell, threaten, or get angry | Acknowledge the patient's emotions* |
| Look down on the patient – remain at their eye level | Restate the patient’s concern |
| Assume you know all the facts | Be empathetic |
Finally, the authors recommend debriefing with the office staff after an incident and modifying the plan, if necessary. Although this approach does not appear to have been studied, it seems like a reasonable framework.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Commentaires
Difficult patients
Good general points
Impact assessment
Excellent
Disruptive Patients and Crystal Meth
Crystal Meth has been a game changer that negates much of the advice given here. Methamphetamine intoxications are inherently unstable, unpredictable and potentially dangerous. I’m an emergency physician and I have personally been involved in several meth assaults, one resulting in my hospitalization. The hospital’s response was more de-escalation training which fails identify this sub-type of disruptive patient as requiring a more comprehensive approach involving support from security personnel. Unfortunately the combination of addictions, mental illness and homelessness has been changing my role as an ER physician to something more resembling a corrections officer. Violence in the ER continues to escalate and I estimate that for every MD assaulted there are at least four nurses injured. This problem is a major cause of “burnout” and demands to be properly addressed.
Angry & Disruptive Patients
Grandma's common sense.
Recommendations for Disruptive Patients in the Emergency Dep
I would be keen to read a similar article aimed at the management of disruptive and angry patients in other outpatient settings, like the emergency department.
Useful reminder
Important to implement early before escalating to violence
very infrequent but good to review
aggression
Management of disruptive patients
Curious to see this published in a GI journal where it will have limited readership. De-escalation techniques are a universal skill required of all health care practitioners, not just physicians. We use them several times a day in the ED.
advice
Agree have forwarded to other physicians