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With Threatening Patients, It’s Safety First

We live in an increasingly angry society. The news is full of stories about violence in once unlikely places on the highways, at sporting events and frequently in the workplace. Disgruntled former employees or unhappy customers, once content with verbal abuse, are using fists and guns to settle perceived wrongs. In the wake of tragic shootings and other acts of violence, hospitals have significantly increased security in what had always been considered a safe environment. Arizona law makes it a Class IV felony for anyone who assaults health care workers in the course of their duties.

The medical office setting is not immune to these senseless displays of violence. How can you and your employees protect yourselves and diffuse potentially volatile patient and family situations? Foremost, it is important to remember that safety comes first. You and your employees should never hesitate to call “911” when you perceive a threat to the personal safety of any physician, staff member or others in your office.

Thankfully, angry patients and family members are usually simply disruptive. Often a few careful steps can keep unpleasant encounters from escalating into violent behavior.

• Do not be drawn into an argument. It is often better to simply listen. Attempts to refute misbeliefs when tempers flare frequently intensify the hostility and are usually non-productive.
• When a patient or family member is loud and angry, answer softly. Quietly lead the offending party away from the common area.
• Refer the angry party to someone with perceived authority. This indicates his/her concerns are being heard and taken seriously. This person may be the office manager, billing supervisor or the physician.
• Avoid becoming defensive. Someone needs to remain rational.
• Take threats seriously but refuse to be “baited.”
• Have someone nearby when you hold a discussion with a volatile person and have a prearranged cue or signal that things may be getting out of hand. This may include the need to call security where available, or even the police.
• Do not meet with angry, threatening patients or others after hours or when no one else is available.
• Abusive phone calls need not be tolerated. A staff member should inform the patient in a calm manner that profanity, abusive or threatening language is inappropriate and the conversation is being terminated. Then hang up and report the matter to the physician or responsible office authority.
• When a patient or family member has been threatening or abusive, warn other staff members to notify the physician or responsible office authority immediately of any further inappropriate behavior.
• Consider terminating a disruptive patient from care or transferring care to another physician whose style may meet the patient’s expectations. Often, once a misunderstanding or unpleasant encounter has occurred, it is difficult to rehabilitate a mutually productive physician/patient relationship. Be sure to notify any involved managed care plan of your reason for terminating or transferring care and follow their requirements for documentation of termination of the relationship.

If a family member is the disruptive party, you may still want to consider terminating your relationship with the patient unless he/she is in a position to prevent the disruptive family member from acting out again. Your responsibility is to the patient, not the family member, and you have a duty to your other patients and your staff to maintain a reasonably safe environment.

Some angry people will threaten other parties who are not present or threaten to harm themselves if they do not get what they want. If you believe at any time that an angry party is a danger to themselves or others, do not hesitate to call the police. Physicians also should be aware when they are required to warn specifically identified or “foreseeable victims” of patient’s threatened violence.

Your office should be a quiet, therapeutic environment. A patient who threatens that environment with loud complaints or threats of violence, need not be tolerated and certainly should not be ignored. Remember the rule of safety first when you or your staff attempts to defuse these volatile situations.

MICA has developed a handout, providing information and form letters for use when terminating the care of a patient. To obtain this information, or for help with a specific situation, MICA members may call MICA Risk Management for assistance at 602-808-2137.