Dealing with the Aggressive Patient

For reasons we can't always put our finger on, some people just seem to have a knack for making us feel uncomfortable. Maybe it's their attitude or tone of voice. It could be a strange feeling we get when we're in their presence. Or we might have an unpleasant history with them that leaves us walking on eggshells every time we find ourselves in the same room.

There's a big difference between someone who's surly and someone who's scary. Surly patients - those who are intimidating, quick-tempered, and argumentative - can usually be handled with patience, reasoning, and by taking time to listen to their concerns.

Scary patients are another story. They can take you from confident to cowering in a heartbeat. And when they do, you need to know in advance how you're going to handle them.

When faced with a frightening patient it's important to take a step back, literally and figuratively. Doing so you will allow you to evaluate the potential cause of their conduct. Are they angry? Worried? High? Mentally ill? In pain? Grieving? Understanding where they're coming from may help you recognize why you're feeling apprehensive.

Your safety, and the safety of your staff and other patients, is always your first concern. That's why security needs to be a priority in your practice. It's your responsibility to assure no one in your office is ever at risk of being harmed, harassed, or horrified by someone else's inappropriate behavior. Here are three suggestions to help you accomplish that.

1. Develop a strategy

Every hospital and medical center in the United States has a formal disaster plan. You need one as well. Even if you're a solo practitioner with a staff of one or two, it's important that everyone knows in advance exactly how to respond if a safety threat arises. Three key elements to consider are, (1) deciding what signal will be used to indicate there's a concern, (2) establishing what roleeach person will play when an alert is sounded (such as who will call security or 911, who will lead the evacuation of the waiting room, or who will assist the person in harm's way), and (3) scheduling a regular rehearsal of the plan, say at a monthly staff meeting.

2. Avoid precarious situations

If you know in advance that a your next patient makes you feel unsafe or has a history of being obnoxious, arrange to have a coworker either accompany you into the examination room or wait nearby, at least until you can get a sense for how things are going. Even then, ask your colleague to stay close. If, on the other hand, a placid patient suddenly becomes volatile, do whatever you can to position yourself near the door so you can swiftly exit if you need to. If things escalate and you think you are in a perilous situation, calmly explain that you need to leave the room. Then call for assistance, without straying too far from the agitated patient. His or her well-being is still a priority.

3. Be clear about consequences

If a patient is chronically cranky, you'll likely have to put up with it. But when he becomes threatening or aggressive, you will need to set clear boundaries. Begin by assuring him that you want to help but you will not tolerate his behavior. If he continues to be a menace to you or your staff, tell him to leave. If he refuses, ask for assistance to walk him to the door of your office or contact law enforcement to escort him out of the building. If the harassment continues, you'll have to explore ways to terminate the patient relationship.

No matter what's behind your unease with certain people, the discomfort you feel is real and it needs to be honored. Even if you're not sure why, whenever something feels "off" it's wise to listen to your intuition by taking time to evaluate and respond to the situation objectively.

Sue Jacquesis The Civility CEO®, a veteran forensic medical investigator turned corporate civility expert, keynote speaker, and author. Jacques helps individuals, businesses, and medical practices gain confidence, earn respect, and prosper through professionalism. She may be reached at Sue@TheCivilityCEO.com.