Tensions can run high from time to time in any workplace, and general practices are no exception. There have been many reports recently of frustrated patients abusing practice team members, both over the phone and in person.
How do you make sure you and your team are safe while managing difficult interactions with patients and their families?
The Australian Medical Association (NSW) recently published an insightful article about how to manage difficult interactions.
1. Good Communication
Good communication is key. While we often think about good communication in terms of how we speak with others, good communication is as much about listening as it is about what we say or how we say it. Sometimes people just want someone to listen and not someone to have an answer.
Acknowledging a patient’s or family member’s concerns can make a real difference to how that person feels and responds to you.
Taking a step back can also be important. At times of high patient demand, are your staffing arrangements such that staff members can have regular breaks to help manage their own stress levels? We all know that as our own stress levels rise, our communication suffers.
2. Try to de-escalate
If a patient or a family member becomes upset during an interaction, think about whether there is another person best placed to try and de-escalate the situation. For example, is there someone in the practice who knows the patient better and may be best placed to speak with them?
If you are involved, and the tensions are continuing to rise rather than lower, know when it is time to step away and / or bring someone else into the conversation.
3. Set boundaries and know what behaviour is unacceptable
Your doctors have yo professional obligations to their patients. That said, those professional obligations do not mean that you and your staff must accept threatening and / or abusive behaviour from patients. If patients are physically or verbally abusive or threatening to you or your staff that is not okay.
Make sure you and your staff know what unacceptable behaviour is, and if this occurs, how it will be handled. A written policy is a great reference for all staff, as is staff training and providing staff (and yourself) with the opportunity to debrief after a difficult interaction. A debrief can be important for a range of reasons, not least of which is assessing what worked and what did not, and what could be done differently in the future.
Be firm with patients if they overstep the mark during their interaction with you or a staff member about what is inappropriate, and what the consequences will be if they do not refrain. For example, if a patient is verbally abusing a staff member, let the patient know their behaviour is not acceptable, and if they do not stop, they will be asked to leave the practice.
4. Be wary of manipulative behaviour
Maintaining professional boundaries is important for your own protection as much as your patients’ protection. Be wary of manipulative patients who may ask you to compromise your standards. While giving in to patients may seem the easier course at the time, it potentially places you in a precarious position. There will come a time when your limits are reached, and once you no longer do as your patient wishes you are left in a vulnerable position should the patient make a complaint about you.
5. Have an emergency procedure in place
In the event that a patient is violent or threatens violence, make sure you are familiar with your practice’s emergency procedure. Do you know how to alert other staff? Is it necessary for the police to be called? Are you able to safely exit the room if necessary?
6. Is it appropriate to end the doctor-patient relationship?
In an emergency you have legal and ethical obligations to assist a patient. In the absence of an emergency, you are not obliged to provide care to a patient.
If unacceptable behaviour is an ongoing issue – or even if it was a significant one-off episode – and you believe the doctor-patient relationship has broken down and it is not in the patient’s best interest, or your best interest, to continue with the doctor-patient relationship, you can take the necessary steps to end the doctor-patient relationship.
If you determine that it is necessary to end the doctor-patient relationship you should assist the patient to transfer their care to another medical practitioner. It may be necessary, depending on the care you are providing to the patient, to continue to see the patient while their care is being transferred. If this is so, you should be clear with your patient about the timeframe within which they are to find another practitioner.
It is advisable to seek advice before doing so to reduce the risk of a patient complaint.
Royal Australian College of General Practitioners resources
The Royal Australian College of General Practitioners has also developed a brief guide to help you and your practice teams identify and manage incidents of patient aggression and violence.
There are some great resources for you and your team to use such as posters and sample patient letter templates.