Doctors should prepare to handle angry patients, for own protection and to avoid complaints, says MPS

The Medical Protection Society is marking Anger Awareness Week by offering advice to doctors who could be confronted by aggressive patients, upset at their perception of some aspect of the service they have received.

Dr Stephanie Bown, director of policy and communications with the leading provider of professional indemnity and advice to health professionals around the world, said the themed week, which runs from December 1 to 7, was an ideal time to highlight a problem that is all too common for medical professionals.

Referring to statistics issued earlier this year by the British Medical Association, Dr Bown said that one in three doctors were attacked at work each year. Although most of these assaults did not involve physical violence, she said it was important for professionals to understand how to defuse these situations. This was not just because verbal outbursts were unpleasant enough in themselves but because they could escalate to physical conflict and the interactions which often prompted the aggression could lead to formal complaints being made too.

Dr Bown added: “Many of these complaints will be completely unjustified, as we know the vast majority of health professionals do deliver an excellent service, despite the pressures they are under, but perceived grievances being raised formally can still have a damaging effect on doctors’ careers and reputations. Often the best way to avoid this is to find a way of correcting inaccurate impressions at the outset, by, for example, calming patients down and explaining why particular types of treatment are necessary.”       

She said the first thing a doctor confronted by an aggressive patient should do was determine whether the behaviour was a manifestation of an underlying medical condition, such as low blood sugar or other cause of cerebral compromise.

Dr Bown said: “If this isn’t the case, it’s important to follow the right procedures. In the case of verbal aggression, a doctor is only entitled to remove a patient from their list if they have given a written warning to the patient within the previous 12 months, setting out the risk of removal and the reasons why this could happen.”

She said best practice in dealing with abusive patient behaviour included being well prepared. This could include obtaining training for doctors and other staff who have face-to-face contact with patients. She said MPS was concerned at statistics which showed only 53 per cent of GPs and 23 per cent of hospital doctors had received  any form of training in dealing with this kind of incident.

Dr Bown added: “Preparation should also include doctors avoiding being alone at the surgery wherever possible, and ensuring they are able to access the exit. Surgery staff should also not leave anything that could be used as a weapon lying around.”

“Where home visits are concerned, doctors should ensure practice staff knew where they were, what they were doing and when they expected to return. She added that if doctors were visiting a patient with a history of aggression or were concerned about going alone for other reasons, they should aim to take someone with them or even request a police escort.

Dr Bown said: “Doctors should be aware that aggressive situations can develop rapidly, particularly if a patient is drunk, mentally ill or a drug addict. They should also remember that the threshold for aggression may be lower than normal where a patient or their accompanying relatives are frightened, in pain or anxious.

“Ultimately when doctors are confronted with aggression, they should call for help if at all possible and try to keep a physical barrier – such as a desk – between them and the patient. They should also try not to escalate the situation, by remaining calm rather than “matching” the patient’s behaviour.”           

Dr Bown said no-one accepts that attacks on medical professionals, whether verbal or physical, were ever justified. She added, however, that they were an unfortunate reality, and it therefore made sense – especially in Anger Awareness Week - for people potentially on the receiving end to be prepared for these situations and know how to deal with them.