Being ill or caring for a sick loved one can be a very stressful experience. When the care provided isn't what the patient or carer expected, this can lead to conflict with health care professionals – perhaps because an error has been made, or the expectations for care are unachievable. Doctors are often asked to make difficult decisions in these tense situations, and it is important to know how to manage this conflict effectively. This will help you to provide appropriate care and avoid formal complaints. The GMC expects doctors to be polite and considerate at all times, even when others are not. 

Avoiding aggression

Confrontations can develop quickly; the first consideration is the safety of you and the patient. If there is a risk of violence you will need support to safely manage the situation, and this should be sought immediately. Some mental health conditions or intoxication with alcohol or drugs can make the patient unpredictable, but also increase their vulnerability. 

If the situation allows it, and before entering into any detailed discussion, consider the patient's confidentiality. Any discussion with a patient about their care should be in private. If the patient is also at risk of violence, this should be actively managed with support from others. Do not be tempted to take an aggressive patient into a consulting room alone. 

It is important to establish the reasons for the patient's anger. Anger can be a reflection of the vulnerability a patient feels. If the patient does not feel they have been listened to, especially if they feel the wrong clinical decision has been made, they may feel trapped – which can lead to a fight-or-flight response. In this situation, active listening can be very effective at reassuring a patient that they have been heard.  

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Anger can be a reflection of the vulnerability a patient feels.

Start by empathising with the patient and acknowledging that they are frustrated or angry and tell them you want to understand what has happened. Then listen to their concerns and repeat back to them what you understand of what they have said. Repeat this process a few times, as it may take a little time for the patient to calm down. If possible, you can then try and agree a way forward. 

If a patient has suffered harm or distress, the GMC states that the doctor should explain what has happened, put matters right if they can and offer an apology. If there is a dispute about the care provided, remember that a patient's right to seek a second opinion should be respected.