Practice Management
December 2021

by Corinne Wohl, MHSA, COE, and John Pinto

While most practices have mastered the initial impact of COVID-19 by implementing new health and safety protocols and have recovered patient volumes, a second phase of challenges has emerged. Staffing shortages, recruiting difficulties, and hostile patients are peaking as practices do their best to adjust to these new realities.

Typical stressors (real and perceived) in medical practice settings that have the potential to upset patients include staff rudeness, mask mandates, or delays waiting for the doctor without explanation. On the other hand, the stressor that sets a patient off may have nothing to do with an experience in your practice; a minor inconvenience could light the fire.

One of our clients mentioned the other day that the doctors in her practice are struggling with how best to respond to a hostile patient. Historically, doctors have not needed the skills to diffuse this kind of anger in patients. Patients generally love their doctors. Practices report that previously minor annoyances such as a poor parking experience or a short wait time have become potentially explosive situations. In many cases the patients are not mad at the practice, but they are feeling generally agitated. In this scenario, there may be little you can do to make them feel less angry. But it can help to be more prepared to de-escalate these situations. This applies more than ever to doctors.

Here are several ways to be well-prepared if hostility is directed at you by a patient.

• As a doctor, you are accustomed to being respected by patients. Use that to attempt to de-escalate the situation by showing empathy. Start with “I’m going to help you with this” or “Please tell me how we can help,” and listen as they talk. Avoid cutting them off or acting defensively as they speak. Any comment that starts with “you” will not diffuse the situation.
• Put yourself in the patient’s shoes, making it easier to be empathetic, but do not lose your authority. Be polite but firm to help keep the situation controlled.
• You may feel personally hurt, unsettled, or become angry and uncomfortable. That is why it is better to be prepared in advance. Occurrences like this have unfortunately become more common.
• You may not be able to make the patient less angry because you and your practice may not have had anything to do with making them angry in the first place. You do have the power, in most cases, to turn the tide of anger by being receptive to the patient’s concerns and encouraging your staff to do the same.
• If you have a management team member who can assist you, call for further assistance, if needed. If the situation is not calming down to your satisfaction, bring in reinforcements, like an administrator who is also prepared to problem solve the issue further, with the same empathy and listening skills used by you.
• It may take some time to diffuse the hostility, and you may feel the pull to move onto other waiting patients. Being able to read the room and work closely with your manager is helpful. Spending some extra time upfront on a situation like this can prevent more severe problems in the future.

Here are additional tips for de-escalation for all practice employees:

• Be respectful.
• Show your intention to assist the patient. “You seem upset; could you tell me about it?” or “I’m sorry this happened to you; what can I do to help?”
• Listen closely. There is a saying “the person who talks next loses.” Allowing someone who is upset to feel that they have some control and are being respected while they explain why they are upset does not diminish your power.
• If possible, and safe, try to move the patient away from other patients. It is easier for everyone to calm down in a quieter location, and you’ll save other patients and staff from the stress of witnessing an altercation.
• Ask open-ended questions about how you can assist. This allows the patient or family member to vent and reduce their stress.
• If it is a mask-related issue, offer to reschedule to a later date, after mask mandates lift, when they will feel more comfortable.
• Keep your responses simple and easy to understand. Avoid overly detailed explanations that could add confusion or be perceived as answers that are defensive and unwelcoming.
• Be aware of your body language. Saying that you appreciate their feedback and want to be helpful while at the same time having your arms crossed in front of you sends a mixed message and is intuitively received as lacking empathy.

When diffusing the situation may not be working, you may need to:

• Call 911. It is better to err on the side of safety and call for assistance if the situation feels threatening. The police can make the decision to remove the patient from the premises.
• Don’t hesitate to work with the police and court system if you want to press charges or establish a restraining order.
• Decide if you want the patient to remain in your care or if you want to terminate the patient/doctor relationship and transfer their care to another practice. In this case, you must legally protect the practice and doctors by following state guidelines for proper notice to the patient and transferring the health record.

Preparing all staff and doctors for uncomfortable and potentially dangerous patient interactions is now sadly necessary and in general, good practice for improving customer service and patient satisfaction. Being prepared can help keep employees and doctors safer during hostile patient encounters, and even if you never need to use your training, the confidence of knowing what to do in these situations will help everyone feel more confident in these difficult times.

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About the authors

John Pinto
President
J. Pinto & Associates
San Diego, California

Corinne Wohl, MHSA, COE
President
C. Wohl & Associates
San Diego California

Contact

Pinto: pintoinc@aol.com
Wohl: czwohl@gmail.com