• The Tough Topic of Dealing with Challenging Patients

    Over the course of my career as a practice manager, I have seen my fair share of patients who are abusive, who appear ‘entitled’, and who are quite demanding. My first thoughts are of disappointment and disheartenment, because working in the health sector is all about helping people to the best of my ability. So when I’m faced with a patient who aggressively acts out, it can make myself, and my staff, feel vulnerable and anxious.

    I can vividly recall our first opening day at my new clinic some years ago now. My business partner and I had put our heart and soul into the design of the practice, trained up our staff, marketed and advertised about our leading doctor who specialises in women’s health, and were generally over the moon with how he had hoped everything would pan out.

    But with an influx of new patients came the arrival of abuse. The reasons behind their aggression? Some didn’t want to sign the privacy form; others didn’t feel the need to watch their children in the brand new playroom whilst they destroyed toys and books. A few left horrible feedback remarks on Health Engine because they weren’t happy they had to pay for their visit, or because clinic staff refused to ‘watch’ their children whilst in with the doctor.

    Basically, no matter what we did on our very first day and within that first week of opening, no matter how nice and understanding we were, patients appeared entitled, aggressive, and rude.

    Some demanding behaviours include questioning why they have to wear a mask, why is the doctor running late, why is it a private billing practice, if they can pay next time, why do they have to wait in the car, and if they can use the clinic phone.

    Most of us accept that we all have bad days. People are tired, bothered, and just want the daily grind to end. But practice managers – and receptionists, nurses and doctors – are all human and we all deserve to be treated with respect, dignity and kindness. Yes, COVID has increased anxiety and depression levels in a lot of people, but it makes me question…has the pandemic made everyone more aggressive, or are we just noticing it more?

    I want to share with you some tips that may alleviate in dealing with such patients. But before I go on, I encourage you to consider having a practice policy put in place to deal with aggressive behaviour and ensure that staff have received training in conflict avoidance.

    When Faced With An Aggressive Or Abusive Patient

    Stay Calm: Listen to what your patient has to say, let them finish their sentence/s. It could be a matter of minor miscommunication, and you may be able to diffuse the situation by staying calm and clearly demonstrating a willingness to help. Stay composed and try to avoid over-reacting. It can be hard not to take things personally, but it’s important to do your best to remain calm and professional.

    Identify The Problem: Allowing the patient to talk and listening to them is a positive way of identifying if your patient has any legitimate concerns or if they’re simply being difficult. Acknowledge you are listening and repeat back their issues.

    Be Empathetic: Asking open questions may help calm the situation, or depending on how you analyse it all, you might feel it’s better to allow the patient to speak uninterrupted. Recognising how they feel is a good way of showing you understand their point of view, but by no means does it show you agree with them. Try not to judge or discount their feelings, pay attention to them, and don’t be afraid of silence. Don’t raise your voice, don’t come off condescending, and be aware of your own body positioning.

    Reassurance: Reassure your patient that you’re listening and you want to help them get to the bottom of the problem, but keep in mind that the safety of you and your staff comes first. So if you are at the stage where your patient is simply not listening to you, refusing to adhere to policies, and is getting aggressive, you have every right to call the police rather than attempting to physically escort them from the premises yourself.

    Compliance Explanation: Here is where you need to stand firm and reiterate that the clinic has compliance policies in place, and that if your patient doesn’t adhere to them, then they are welcome to leave and go elsewhere. It’s more or less a warning about their behaviour without using the word ‘warning’ as that can be triggering. If they continue to disagree aggressively or abusively, inform them the police will be called and they will be physically removed from the clinic.

    Respond In Writing: Debriefing with staff and support colleagues can be valuable and generate incredibly useful learning points to prevent or manage similar situations in the future. You have every right to document the patient’s behaviour in their medical files with the doctor if you believe their aggression is related to a health issue; if it has nothing to do with their health, or you don’t have their file on hand because they are new, a police report can be filed. The person could in fact be a repeat offender, and you might not know it.

    Safety: If at any point you or your staff feel unsafe, leave the area and call security or police immediately. Always remain a safe distance away from the patient while in a confrontation, and remove yourself if it starts to get out of hand.

    I’ve attached some links for more resource information that you all mind find useful if the need should arise.

    How To Deal With Patient Complaints

    Preventing & Managing Patient Aggression & Violence by the RACGP

    The medical industry is a hard road to take, and there have been times I’ve driven home in tears. But I always make sure I remind myself how much I love being there for people, and how much the happy, kind patients far outweigh the negative ones.

    If you have any tips or suggestions to share with your fellow practice managers on how to safely deal with challenging patients, we would really like to hear from you.