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A faulty production line

What I learned from an encounter with an angry patient

Dr Shyamala Balendran offers her advice for dealing with this tricky situation

A middle-aged male patient presented to my clinic on Monday morning. He attended because he wanted a prescription for vitamins; I began to explain that we don’t routinely prescribe vitamins. He quickly started to become agitated. He was shouting and shaking his fingers in my face. He used abusive language, saying things like, ‘You are my servant and should do what I tell you’, and told me that ‘people from your culture wouldn’t understand’. This went on for about 20 minutes; eventually I asked him to leave.

After this consultation I had a discussion with my practice manager and senior partners to find out how these incidents are managed. My GP surgery has a ‘zero tolerance’ policy on aggressive patients. The policy states that the practice considers ‘aggressive behaviour to be any personal, abusive and aggressive comments, cursing and/or swearing, physical contact and aggressive gestures’. The practice policy also states that no abuse of staff is acceptable, whether verbal or physical.

The first thing I learned was that our practice policy states that patients who are aggressive – but not violent – get a written warning from the practice. If he gets three more warnings in the next 12 months, he will be removed from the practice list. I feel that it is important that all staff are aware of the practice policy on aggressive patients. This is especially important for administrative staff, as they are probably on the receiving end of most of the aggressive behaviour in the surgery.

The second thing I learned was that we may want to consider an alternative to the panic button system.

Most GP consultation rooms have a panic button and this may be useful in the event of a medical emergency (where you need to quickly call for assistance) or if you feel that a patient is at risk of imminently becoming violent. The panic button summons assistance from multiple sources, without the patient being aware. However, if a patient is verbally aggressive or abusive, I think that this may not be a very appropriate tool. In these situations the clinician probably doesn’t require the assistance of a group of colleagues, but would appreciate the intervention of one. Certainly during my consultation, I don’t think that pressing the panic button would have been the most effective method of dealing with this irate individual. It makes me wonder whether practices should have a more subtle method that doctors can use to let the practice or reception manager know that their help is required.

In my current practice we have a green panic button on the desktop of the computer. However there are many practices, including the last place I worked, that have panic buttons attached to furniture or walls. In the event of a hostile situation, I would have had to ask my attacker to give me a minute while I ran to the corner of the room to press the button.

The third thing was that we GPs would benefit from is more training. I qualified as a GP in 2010 and during our VTS programme we had a little bit of training on dealing with aggressive patients, but the best advice I received came during hospital jobs in psychiatry.

I have found that reflecting on my experience in psychiatry has helped me a great deal. Professor Clare Gerada has said that four year GP training would be the College’s ‘gift to the next generation’. I feel that increasing training (and more specifically ensuring that doctors have had placements in psychiatry) would improve doctors’ skills in dealing with such situations.

And the last thing I learned? We need to listen to patients and to each other. I think it is important that practices have regular meetings to provide clinicians with a forum to discuss patients that they may be having difficulties with.  A team approach should be adopted so that the individual does not feel that they are alone. We should not feel that we have to put up with inappropriate behaviour in the workplace. Patients and doctors do not need to agree all of the time but we do need to treat each other with respect.

Dr Shyamala Balendran is a GP in Canterbury.


Readers' comments (9)

  • I agee that whilst the patients are increasing being told regarding their rights they should also be told about their responsibilities (including being civil) by the government and the media.
    We should also be open to them about limitations due to government / financial restraints.

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  • This article is spot one!!!

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  • I mean spot on!!!

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  • Dr.Balendran, you dont need an extra year of VTS training just to learn how to deal with an aggressive patient. We need to focus on the problem. This kind of behaviour is seen as acceptable to some patients because they clearly do not have any respect for the clinician they see. Maybe that has something to do with the complaint culture of this society. Anyway maybe the RCGP will add another year to VTS training to make 5 years so that we can reflect on that too

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  • Cobblers

    Sorry that is FOUR warnings in a year for verbally aggressive behaviour??

    Dear me what are you some kind of verbal punch bag?

    My suggestion is that you yellow card someone and write and tell them so. This should result in an immediate change of behaviour. Failure to adhere to acceptable societal norms means red card and off list.

    Physical violence is an immediate red card and off list. Inform Police and PCT.

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  • Hi Dr Balendran,
    I know the feeling.One never learns how to deal with angry patients who have unrealistic demands in a free at the point of deliver health service.We as GPs are easy targets for patients. Patients do not behave like this with consultants.

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  • A bit of training in calming angry people down might have been helpful. Or a simple query like "tell me a bit more about your need for vitamins" instead of immediately going into the "we don't prescribe vitamins" mode. That way he would know you were taking him seriously and were interested and he might not have ended up getting shouty and angry.

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  • My experience with these type of patients is that no matter what you say or do that they will not be satisfied. There minds have been made up before you even see them, they are looking for conflict! Sadly no amount of pacification will resolve the situation , chucking them out is usually the only remedy.

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  • I think the mistake here is to start with a blanket refusal to do what the patient wants. This will immediately provoke an aggressive or defensive response. If one gently finds out what he needs and why you can usually have a mature discussion on whether it is appropriate. Is he perhaps an alchoholic? The same conflict would arise when an mother comes in requesting antibiotics for a child with respiratory infection. To start off with a "We dont prescirbe antibiotics for colds" is going to trigger a conflict situation. Examine the child first and then discuss treatment.

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