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A faulty production line

We have to stop making excuses for abusive patients

Dr Zoe Norris

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I have two children, both girls. I know all the rules of projecting confidence – never criticise yourself in front of your kids, never say you are fat or ugly, be a strong, confident role model. Easier said than done.

But this shouldn’t really be an issue at work. Like most of us, I put my work mask on – metaphorically and literally (thanks Clinique), and I go to work. I’m not self-critical in front of patients as I want them to believe I’m a big, grown-up GP they can trust.

But as GPs, our actions mean we are fooling no one. We suffer from dreadfully low self-esteem. Hours spent learning consultation skills doesn’t change the fact that most GPs are like puppies. We want to be loved. When colleagues or patients kick us, we slink away whimpering apologetically, when really we should bite their ankles.

We should learn from other people’s attitudes – even those of our own staff. I overheard one of our receptionists getting a hard time the other day. As the patient became more irate, she’d had enough: ‘I’m not going to help you if you speak to me like that. It’s not acceptable.’ You go girl, I thought, with an American-style air-punch. She had been firm but polite and dealt with it.

We’re so scared of complaints that we won’t stand up for ourselves

Contrast this with GPs’ approach. That night on Facebook I saw several stories from doctors who’d been spoken to abusively by patients. Some involved general anger or rudeness, some overt racism or sexism. Hardly any of the doctors had responded like my receptionist. They hadn’t stuck up for themselves and called time. They’d persevered with the consultation, taking ever more abuse.

They even made excuses on behalf of the patients: ‘I was running late so he was already fed up…’; ‘She had waited three weeks for an appointment…’; ‘If I had handled it better…’

No. No no no. We’re so scared of complaints that we won’t stand up for ourselves. But there is no excuse for aggressive or abusive behaviour towards people who are trying to help. Pain, illness, poverty, alcohol, drugs, social situation – none of those justifies abuse.

We need to stop making excuses for patients who behave like this, and give it to them straight. Zero tolerance. You don’t swear at us, and you don’t speak to us or our staff in an aggressive way. If you do, warning letter. Do it again and you can find another GP. ‘But,’ I hear you say wringing your hands, ‘we are the only surgery nearby and it wouldn’t be fair to make the patient travel.’ Well, that’s what the warning letter is for.

I write this within 24 hours of two of our colleagues in the profession being seriously assaulted in their consulting rooms. Both need surgery. There but for the grace of god go all of us.

We’re highly qualified, hardworking professionals. We need to have some respect for ourselves and for our staff, and stop taking crap from patients or making excuses for them. And to anyone who thinks they deserve this abuse, I suggest CBT and some time off. Maybe if we start valuing ourselves, we might stop being the dumping ground for others’ problems, and the doormat of the NHS.

I’m off to buy some killer heels so they can hear me coming on Monday morning.

Dr Zoe Norris is a GP in Hull 




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Readers' comments (19)

  • National Hopeless Service

    I totally agree. I am fed up of having to excuse the current state of the NHS and I will no longer accept rudeness from patients because of it. They can be rude to their MP not me. I am also given more robust responses to anonymous NHS Choices comments.

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  • Well, I locum a lot and come across rude and abusive patient frequently. My way of dealing with them is to show them the door followed by a message to the pm. However, the partner dealing with inevitable complaint usually goes aaaah poor patient and develops a poor opinion of the nasty locum. Such a shame as this teaches rude patients how to be ruder as they usually get an apology and easy appointments.

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  • Nice one! Feel I’ve been better off for standing up for myself over the years - literally and on occasion nose to nose shouting back. It helps I’m 6ft 3in and it’s not for everyone, however the shock and horror on the faces of the abusers can be something to behild - “...No YOU F**** off!!” Often followed by “...errr you can’t talk to me like that - you’re a doctor?!?!?!” - Well I can and I do.
    It’s often a surprise to the abusing patient that I/we push back and aren’t just a vessel for there vileness - in fact on reflection, not pushing back seems to make matters worse as nobreaction or an apologetic one is like a red rag to a bull.

    I do hope however that the perpetrators of the physical abuse metred out to the 2 GPs feel the full weight of the law and we can use these as examples so as to help prevent any further attacks. (...would this be a deterrent?!)

    I may have been in a Brexit/World Cup/Thai cave bubble but why didn’t I hear of these attacks - surely this is ‘news’ ??

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  • Macaque

    After reading this article I ended up reading the GMC guidance on "Ending your professional relationship with a patient".

    So give a warning, and then asking the patient to go somewhere else it is! I think the Daily Fail and EDL Express should do a headline on this some time.

    To give a warning or strike an abusive patient off, all the partners have to agree. This is where I have seen problems in the past.

    I have seen the GPs who experienced abuse from patients being marginalised by the other GP partners as having communication problems, and the patients given a pats on the back.

    Do you know a GP who love collecting thank you cards from patients and do whatever needed to please them? Obviously not a keen evidence based practitioner with a significant list of patients on cocktails of opiates, benzos and pentins?

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  • Well said.

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  • 'We suffer from dreadfully low self-esteem.'
    This statement couldn't be any more true. It is also reflected on how we deal with secondary care colleagues and that is why some of them think they are 'superior' Shame!

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  • Totally true ! Well said. Lets go girls ! ( and boys !!!).

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  • Yes one patient interaction 2 years ago cause me such stress (I felt severely threatened) that I now have PTSD and fibromyalgia and have resigned my partnership

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  • I agree. And there's nothing worse than going to a colleague for support and them saying, "Aw, he/she's always all right with ME, what did you say to him/her?" as if it's the GP's fault that the patient kicked off.

    One of my colleagues was on the receiving end of racial abuse from a patient a few weeks ago and the practice manager's response was to placate the patient to try to avoid a complaint instead of removing them from the practice list and reporting them to the police. Unbelievable!

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  • Pale, male, stale
    Not sure what a nobreaction is, but likely GMCable!

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  • my experience as a locum is that the NHS repeatedly sacrifices staff rather than face down unreasonable complaints. Some GPs are the worst offenders, whereas others are highly supportive. NHS England however consistently colludes with abusive patients.

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  • Essentially patients are allowed to bully GPs and do. One bullying tool they use a lot is the Complaint system.

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  • Really well written article Zoe. I completely agree. I think zero tolerance should mean striking patients off lists as soon as they do anything aggressive. I think the zero tolerance posters should be displaced in huge font above the reception and that should act as a first warning.

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  • The article is nonsense and divorced from reality! Did I abuse anybody by saying this? I did not!

    Reality is a harder place. The reality at the moment is that the customer (aka service user) is always right - and they have some powerful muscle on their side. Until it becomes standard (lawful) practice to record all consultations, the problem of challenging abuse by patients will remain. Taking issue with abusive patients is a time-consuming stressful experience. Do you have time for any of that? You do not!

    Sure the principle of not tolerating abuse is fine - but the reality of challenging it is not fine. Step out of your fantasy worlds for a change.

    My strategy for managing abuse is simply to pretend it's water on a ducks back. They could say whatever they want. I document verbatim what is said. I refuse to see on a subsequent occasion - and if my masters wanna take issue with me, I have the evidence for my actions. If they start forcing me to tolerate abuse, I'll then pelt them with the NHS Zero Tolerance policy. Is that okayyyyyy? [Now some will have identified 'Alias Nobody'. LOL]

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  • And the Achilles' heel of all this is that if the patient decides to make a complaint to the CCG, as like as not the doctor will be hauled in for criticism: ditto the GMC; and ditto the ombudsman (to say nothing of the media).
    Yet we cannot be expected to show discipline and strength (including toeing the party line over, say, prescriptions) if those managing us always cave in and assume that the doctor is always wrong. Indeed, the patient wins even if the professional(technically) wins, because with a bit of luck (according to the patient) responding to the allegation of unprofessional behavior will cause you so many sleepless nights, and waste so much of your precious time that that of itself with be punishment enough as far as the really unpleasant patient is concerned (and will also tend to make you never want to do it again).
    Yes, there are some GPs and staff at fault out there and I don't want to sound as though I am standing up for them inappropriately -- but we need a complaints situation which is truly even-handed, whereby if the doctor is deemed to be not guilty of the subject of a formal complaint, then ALL the costs of the hearing (including the doctors legal fees) have to be paid by the patient, AND there is a 'victim surcharge' that they also have to pay.
    The bottom line is this: complaints cannot ever be one-sided, but at the moment the boot is far too far on the side of the over-demanding patient.

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  • As a locum I get people who come and feels it is ok to be rude and/or late like a supply teacher but I am usually firm and fair I will tell them it is not acceptable. For too long I thought it is better to keep peace and bite my tongue but what I find it I would be driving home and be kicking myself for not saying anything and be annoyed so now I say it to them. Quite a few people are totally unrepentant but then someone needs to tell them they are rude and it looks like no one has so far. Unfortunately, there is no point turning to the useless GMC or DoH all they say it well it is "unacceptable" what a pointless and toothless comment.

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  • I don't agree with the argument that it is too much trouble to challenge bad behaviour. By not challenging it we make it alright and it increaces.

    I one got told "I pay your wage". I told the patient I'd never make 6 million, there were 60 million in the country, gave her 10p backand asked her to leave. We then had a good consult as boundaries had been established.

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  • I feel very strongly about this. I had a male patient 6 foot plus who always insisted on seeing me, often at short notice. He has been repeatedly abusive to reception staff as well as myself. He was sent a zero tolerance letter following chucking an object at one of reception. Following a consultation where he called me a f***ing c**t I asked him to leave. He complained to NHSE and I was criticised. Makes my blood boil.

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  • My "resilience" advice to everyone is - just make sure the patient cannot complain on the grounds of anything clinical. Just make sure you did everything clinically right.
    Complaints about attitude, language, etc. are water off a duck's back.

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