In your practice, you may encounter a ‘difficult’ patient, someone angry, stressed, demanding or dissatisfied with a service or treatment.
All doctors are likely, at some point in their careers, to be involved in dealing with a difficult patient. It is important to be able to recognise why patients are unhappy and implement the right strategies so that both you and patient achieve the best outcome.
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1 – Recognise the issue
When patients complain or behave in a challenging way, it’s rarely for no reason. Reviewing who or what may contribute to these situations helps you prepare for how to manage them should they arise.
- Is the patient stressed or anxious about their health or something else going on in their life? Opening communication channels with the patient can help them feel validated and calm an escalating situation.
- Could your team’s interpersonal approach be contributing? Similar to the point above, if someone on your staff is having a bad day and this affects their service delivery, it could upset a patient. How do you support your staff so their stress doesn’t impact their performance or a patient?
- Do your systems and processes enhance or hinder the patient experience? No one likes doctors running late, missed follow-ups or billing hiccups. Do you have practice policies and procedures for dealing with these occurrences? For example, calling or texting a patient before they arrive to tell them a doctor is running behind.
2 – Create a risk strategy
Difficult patient situations are a potential risk to your practice, so you need to include strategies and processes for dealing with them in your broader risk management strategy.
The first step is to assess what the risks are to your practice from difficult patient behaviour – from mild to aggressive and violent. Then, you and your staff can decide on your strategies to manage and control these risks.
Emergency protocols such as these help keep you, your staff and patients safe:
- Make sure your reception and consultation room doorways can’t be blocked by someone.
- Install a security ‘panic button’ at reception, and have protocols on how to respond when the ‘panic button’ is activated, including ensuring staff know when and how to call the police if they feel threatened by a patient’s behaviour.
- Decide on ways to alert other staff at the practice if an incident arises.
- Ensure more than one team member is at the practice at all times when patients are present.
- Workshop with your team on ways to deal with a difficult patient, role-play scenarios, so staff know what to do in an escalating situation and develop a script for staff to follow.
Document your strategies for managing difficult patient behaviour, along with your emergency protocol, in your policies and procedures manual. You can do this easily with an online practice management platform like PracticeHub, and link these policies to your overarching risk strategy, as well as external resources such as legislative guidelines, and your practice indemnity insurer. Doing this not only makes your documents easier to find, it helps staff understand the bigger picture of your practice risk management.
3 – Review patient communication policies
Many challenging patient situations can be defused or prevented by clear communication, acknowledgement of grievances, and open disclosure of adverse events.
Some patient communication strategies to consider:
- Practise active listening
If a patient becomes difficult, rather than become defensive, allow them the opportunity to speak, ask them questions to clarify their concerns and actively listen. When you acknowledge their feelings and stay calm, it can help ease any tension and help a patient feel heard. This reassures them you want to help. - Open disclosure
Adverse events happen despite your best care, and it’s important to manage them as soon as possible, to avoid further upsetting to an impacted patient or their family, and reduce the risk of a claim or complaint. Ensure your practice follows the open disclosure protocols required by the RACGP and National Safety and Quality Health Service Standards. - Set boundaries with a policy on expected patient behaviour
While it’s important to show patients you understand and acknowledge their grievances, you and your team don’t have to tolerate aggressive or violent behaviour. Create a policy on the respectful behaviour you expect from patients and promote it with signage around your practice, so patients understand your ‘zero tolerance’ of unacceptable behaviour.
With PracticeHub, there are RACGP Standards-aligned policy templates onboard, including those on patient communication and risk management. These templates can be customised to suit your practice’s preferred processes and easily updated as legislation changes. There are also policy training modules, to ensure your staff stay current and compliant in their patient communication and risk management processes.
4 – Provide support for yourself and staff
When unsettling patient situations occur despite your prevention and mitigation efforts, it’s important to follow up with your team afterwards to check on their wellbeing and see what can be learned to prevent it from happening again. The RACGP’s Preventing and managing patient aggression and violence guide recommends completing an incident report and filing it in your practice’s adverse events register. The guide also suggests discussing with staff:
- what measures worked, and why
- what didn’t work, and why
- what alternatives and extra safeguards can be trialled.
PracticeHub’s customisable in-built registers make this process easy. Having an online register makes it easy for staff to access, and for you to update as further risk management changes are made.
5 – Documentation
As we’ve seen, documentation is a crucial part of effective risk management and handling challenging patients, not only to guide your team’s response, but for evidence in the event of a patient claim or complaint to a regulator. When documenting adverse events or challenging interactions with patients, keep the details factual and objective. And when you create or update your patient communication policies, ensure all staff read and understand them, with a requirement that they sign off on each policy. In PracticeHub, staff are automatically alerted when they need to read and sign off on a new or updated policy.
This gives you peace of mind that the whole team is across how your practice manages patient communication and difficult situations.
Learn how PracticeHub’s policies and procedures help you run a safer, better quality practice. Book a consultation or call 1300 96 86 36.
Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Avant and PracticeHub are not responsible to you or anyone else for any loss suffered in connection with the use of this information. Information is only current at the date initially published. © Avant Mutual Group Limited 2021.
