How should clinicians manage angry and disruptive patients?
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.
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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.
*If the patient is yelling or threatening, inform the patient that you are leaving the room and will return when s/he is calmer.
| Do Not
|Crowd or touch the patient
||Give the patient your full attention
|Let the patient get between you and the door
|Interrupt the patient
|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
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.
Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI