Steps to recognize and manage angry and disruptive patients

Clinical Question

How should clinicians manage angry and disruptive patients?

Bottom line

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

Study design: Other

Funding: Self-funded or unfunded

Setting: Outpatient (any)


Henry C. Barry, MD, MS
Michigan State University
East Lansing, MI

Discuss this POEM



Difficult patients

Good general points


Impact assessment


Brian Colborne

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.

Joseph Harris Finkler

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


Pieter Richard Verbeek

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.



Agree have forwarded to other physicians