- Introduction
- Zero Tolerance Policy
- Known Patients with Illness-Intrinsic Aggressive Behaviour
- How to Prepare
- What To Do in a Difficult Patient Interaction
- What To Do in More Intense Situations
- 📵 Patient being abusive on phone:
- 🪑 Violence in the waiting room:
- 🙅 Violence in a face-to-face appointment:
- The Aftermath
Introduction
Anger is a common and normal emotion. We have all felt it at least once, and our patients feel it, too. When a patient acts in an aggressive way, keep in mind that it most likely has nothing to do with you personally. Patient anger/frustration can occur for a variety of external reasons (e.g. pressures at home, mental illness, feelings of loss of control/powerlessness, etc.). Take a breath and try some de-escalation tactics.
Zero Tolerance Policy
We try to keep all of our patients as calm as possible and encourage using de-escalation techniques where necessary. However, there are times when, no matter how understanding, patient and good you are at de-escalation, a patient is just out of control and downright abusive or violent.
We support our staff and exercise the NHS Zero Tolerance policy.
That means that if a patient directs any physical or verbal abuse towards our staff, the matter will be discussed with the patient involved and it may result in removal of the patient from the Practice List.
Patients are informed of our Zero Tolerance policy via our websites and through posters in our waiting rooms. However, in appropriate cases you should also feel comfortable to tactfully inform/remind patients of this policy.
Known Patients with Illness-Intrinsic Aggressive Behaviour
The Practice acknowledges that there may be instances where violence and/or aggression forms part of a patient’s illness. In these circumstances, the issue will be discussed with the patient and form part of their care planning.
Care Planning for illness related aggression means that:
- it is recorded in patient’s medical record
- it is flagged in warnings to ensure all staff are aware
- where deemed necessary, appropriate support will be put in place (e.g. staff member does not see the patient alone)
How to Prepare
Preventative measures should be arranged when staff are treating such patients or any patient identified as posing a risk to staff, contractor or patient safety. In addition, the clinician may consider:
- Having a chaperone present throughout the consultation
- Arranging the surgery to ensure the clinician is seated closest to an escape route
- Ensuring other staff are aware of a potential issue and are prepared to respond accordingly
The purpose of the SAS is to deal with patients who are violent or aggressive. It aims to protect GPs, practice staff and patients who have the right to be in the practice without fear of intimidating behaviour.
The SAS refers patients with a history of violent behaviour to designated GP practices who provide services by appointment at specific locations and times, as detailed in individually agreed contracts. Patients join the scheme after being immediately removed as a result of an incident that was reported to the police.
What To Do in a Difficult Patient Interaction
You will have received some training regarding dealing with difficult patient interactions.
Remember, it is important to try to take control of the situation, rather than the person. Steps for safety to consider are:
- Stay calm → de-escalation requires taking things down a notch, not heating them up with a good argument. (See box ▶️ for de-escalation advice).
- Be mindful of your safety → consider your escape routes, and/or if you feel you need another colleague to be with you, contact them.
- Call your Line Manager, the Patient Care Manager, or Operations Director immediately → if the situation escalates and/or you feel afraid or uncertain about what to do next (e.g., threat of physical violence, loud and abusive language, etc.).
- Call the police → if an abusive situation seems likely to become violent (e.g., person is about to assault someone or cause damage to premises).
- Never → try to remove the person from the premises yourself. (Manage the situation, not the person).
- Afterwards → you must report the incident through our difficult patient interaction form. We'll use this information to investigate the interaction (e.g., through reviewing call recordings, CCTV, and notes).
- Allow the patient to vent.
- Acknowledge the issue (recap it back to patient to show that you ‘get it’) & show empathy.
- Buy time and focus on a solution - if patient is requesting something out of the ordinary, don’t say an outright “no”. Instead you can say something like “that is not normal policy, but let me check with my line manager and see what can be done.”
- Never promise something that you cannot deliver.
What To Do in More Intense Situations
📵 Patient being abusive on phone:
- Try handing it to a colleague or team leader.
- End the call (see box ▶️ for appropriate phrasing) and inform your Line Manager.
🪑 Violence in the waiting room:
- Dial 999 to call the police.
- Use the emergency panic alarm button on EMIS to alert staff.
- Evacuate other patients from the waiting room.
- Work as a team → do not put yourself or your colleagues in danger.
🙅 Violence in a face-to-face appointment:
- Use the emergency panic alarm button on EMIS.
- Once other members of staff have arrived → all staff present will assess the situation.
- If additional staff for support are necessary, or if the police are required, the present staff members will arrange this.
"I would like to help you, but I don't feel comfortable with the language you are using. If we could move forward, I will do my best to help (give the patient a minute to see if there is a change of tone/language). If we can't move past this, I am sorry but I will have to end this call. My team leader would be happy to call you later to discuss the matter further."
The Aftermath
If it had been necessary to call the police to have a person removed, all staff involved in the incident should make a written statement, including exact words used by the perpetrator. We’d encourage you to just write these in a short email to your line manager as soon as you are reasonably able, to help ensure you don’t forget any pertinent information. Although most of our public areas our covered by CCTV, there is always a risk that it fails or does not capture the specific detail that you may have experienced.
If any person is injured in an altercation, no matter how minor, it must be recorded as a Significant Events (to fill out form: click link or go to the Penrose Portal homepage). If hospitalisation is not required, the injured person should be advised to consult with a doctor before leaving the premises.
We will take action as appropriate with the patient - this could include sending them a warning letter, or removing them from our Patient List. We may not always action this immediately, but be assured that it is kept logged on our system.