Unfortunately, virtually all doctors, nurses and healthcare professionals will encounter unacceptable patient behavior at some point in their careers. This unacceptable behavior can take many forms, ranging from threats and verbal abuse to intimidation and sexual harassment.
Knowing how to deal with this type of behavior in a professional, ethical and appropriate manner will help healthcare workers to keep themselves safe, diffuse situations and create a more secure work environment.
What Types of Behavior Are Unacceptable?
There are lots of types of patient behavior that are unacceptable. In general, any behaviors that make you feel uncomfortable or threatened can be seen as inappropriate. The most common types of inappropriate behavior that healthcare professionals experience are:
- Verbal threats
- Physical intimidation
- Racist comments
- Sexist comments
- Rudeness
- Sarcasm
- Sexual touching
- Suggestive comments
- Racism/misogyny
However, inappropriate patient behavior is not limited to these categories, and it can take a number of different forms.
Is There a Reason for What They're Doing?
Though rude, threatening or disrespectful behavior is never acceptable, it’s important to try to understand why a patient may be behaving in this way. Considering possible causes can help you to handle the situation appropriately. Taking the time to see things from your patient’s point of view may make it easier to diffuse their anger and to treat them effectively.
In some cases, patients and family members may become angry or frustrated if they’ve had to wait a long time for treatment, or if they feel that their concerns are not being taken seriously. In these instances, you may need to apologize for the wait or sit down with them to show that you’re really listening to what they have to say.
In other cases, there could be a medical reason for the disruptive behavior. Mental health issues, and conditions like dementia and Alzheimer’s, can cause patients to act aggressively and erratically. Alcohol and drug use can also lead to bad behavior. If you suspect your patient has ingested drugs or alcohol, or has a mental health issue, you may need to call in backup to help you deal with the patient until their treatment takes effect.
If there’s no obvious cause for the unacceptable behavior, it might be time to call for hospital security or inform your practice manager. Threatening, aggressive or disruptive behavior shouldn’t be tolerated, especially if it puts staff or patient safety at risk.
Handling Racism and Bigotry
Hospitals are often very diverse places, with both staff members and patients coming from a wide range of backgrounds. As a result, it’s not uncommon for a patient to be treated by a clinician with a totally different heritage or culture. This can result in patients requesting to see different doctors or even making bigoted or racist comments.
The American Medical Association (AMA) recommends that patients who act in a derogatory manner be transferred to another provider. It also states that, while a patient should be respected, their bigoted or racist views should not be.
Everyone, Including Staff, Deserves to Be Respected
All hospitals and treatment centers should make it clear that everyone using the premises, including staff, deserves to be respected. This can be done by placing notices around a hospital or medical center stating that there is a zero-tolerance policy on aggressive, violent or otherwise inappropriate behavior and that patients and staff are required to be respectful at all times.
Preparing Your Team
Team members should be prepared for unacceptable behavior and taught how to cope with difficult situations. This will give all staff the tools they need to manage patient care and deal with challenging patients in a professional manner.
Team members should also be trained in the appropriate use of panic buttons and personal alarms. Panic buttons for healthcare workers can be used to quickly and silently call for help if a professional is threatened or assaulted by a patient. Learning when and where to use panic buttons will help team members to feel safer when at work.
A good example of healthcare professionals dealing with unacceptable behavior can be found in the JAMA Internal Medicine essay Inappropriate Behavior by Patients and Their Families—Call It Out
by Dr Amy Nicole Cowan. In it, Cowan describes how a family she saw didn’t want to be cared for by a Muslim medical student or be treated by her because she was a woman.
Cowan used this experience to develop methods of dealing with these types of situations. One of her most important recommendations is to be firm in the face of unacceptable behavior. She also suggests medical professionals have a short reply ready to warn patients before behavior deteriorates. Cowan advises that coping strategies be taught to students in medical school.
Tips for Dealing with Patients
Set Physical Boundaries
If a patient has touched a staff member inappropriately or made verbal threats or suggestive comments, it can help to set physical boundaries between the patient and the staff treating them. Doctors or nurses should tell a patient clearly and firmly that physical contact is not allowed and that their actions are unacceptable. If the behavior continues, they may need to call in security personnel or a co-worker.
Involve Your Co-Workers
Sometimes, patients don’t respond to verbal warnings. This is especially common when the person is suffering from a mental health condition or has taken drugs or alcohol.
In these cases, two members of staff should attend to the patient instead of one. This will minimize the opportunity for such behavior and make professionals feel safer. Having two people in the room can also reduce the chances that a patient accuses a professional of malpractice or inappropriate behavior at a later date.
Have a Reply Planned
All medical professionals should have a short, firm reply ready for patients acting in an unacceptable manner. These replies should be clear and professional and leave no room for misinterpretation.
Be Firm with Your Response
It’s important to be firm with your response to unacceptable behavior. If the patient doesn’t amend their behavior following a warning, security personnel should be called and the patient told that they may be transferred if the behavior continues.
Documenting Patient Behavior
Whenever unacceptable patient behavior occurs, it should be thoroughly documented. This documentation can be used to help train staff members and to provide evidence in case of criminal prosecution.
When and How to Dismiss a Patient
If a patient doesn’t respond to warnings and continues to act in an unacceptable manner, it may be necessary to dismiss them. If you find there’s no other option but to transfer or dismiss the patient, you should explain the situation to them as calmly and clearly as possible.
Exposure to unacceptable behavior can put pressure on doctors and nurses and lead to burnout, stress and anxiety. Learning how to effectively deal with this type of behavior can help to boost teamwork, reduce staff turnover and improve the overall health system.
Find out more about coping with violence in the workplace and learn how our panic button systems are already protecting health service workers across the country, by taking a look around or getting in touch with a member of our team.
