Dr Edward Farnan
Keep yourself, your patients and colleagues safe by learning how to stay in control and defuse a tense situation.
All doctors are likely to come into contact with angry patients or their relatives – particularly if you're working in general practice, psychiatry or the emergency department, although it's possible to encounter aggression anywhere.
It's important to learn how to recognise potential anger and take steps to address it, for your benefit and that of your patient.
Reasons for anger
Patients can become aggressive or violent for a number of reasons.
They can be triggered by an underlying medical problem – an acute physical or mental illness may make someone behave in a way that isn't in keeping with their character when they are well.
Bad news, fear and misunderstanding can all make a person behave unpredictably. This can be exacerbated if a patient thinks they haven't been seen quickly enough, or if they feel that a clinician hasn't recognised their level of distress.
Miscommunication, language barriers, previous poor experience and unrealistic expectations can also contribute to a patient's feelings of irritation and cause them to act in anger.
Read the signs
You could find yourself mid-consultation when you start sensing a patient is unhappy with the way things are going. It's important to be aware that a situation could be escalating, even in patients with no history of challenging behaviour.
Observe their manner – look out for what they say and how they say it. Irritable comments, sighing and agitation can all be signs that a patient's anger is building up. Their frustration can also manifest itself as demanding or controlling behaviour; lack of co-operation or unwillingness to listen; verbal threats or – more rarely – physical violence.
It's important to be aware that a situation could be escalating, even in patients with no history of challenging behaviour.
Acknowledge the patient's frustration
Show the patient that you recognise they are unhappy, and that you want to understand why. Ask open-ended questions and don't encroach on their personal space, in case that increases tension.
Give them an opportunity to share their fears or frustrations and see if you can find a way to resolve them. Feeling that they are not being heard or their worries are being ignored can make a patient's irritation heighten.
Although thankfully rare, anger can sometimes turn to violence. Some patients might have a history of violence; others might become momentarily aggressive because of pain, psychosis, confusion, fear or intoxication.
Make sure you know where the panic buttons are in your consulting room or department, and know how to use them just in case.
It's OK to end a consultation if a patient is becoming increasingly angry and you don't think the situation is likely to improve – particularly if you feel there is an imminent risk of physical aggression.
Take a moment
After a difficult situation or an incident where you've felt threatened or vulnerable, take a quick break before you see the next patient. It's best that you go into your next consultation feeling calm and in control – you'll be more attentive and more likely to avoid a similar incident happening again.
It can also be useful to discuss what you've been through with a colleague or your supervisor.
Dr Edward Farnan
MB BCh BAO LLM FRCGP DGM DCH DRCOG
Dr Farnan graduated from Queen's University, Belfast, in 1995 and completed his GP training in Northern Ireland, practising as a principal in general practice in Armagh for 11 years. He also sat on a research ethics committee, and had a particular interest in clinical governance.
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