Dealing with Disruptive Patients

Disruptive behavior is any conduct that hinders a provider’s ability to administer care.

Disruptive patients are a common problem for medical practices. These patients can cause stress for staff members and may upset other patients. How can your practice deal with these patients? 

Disruptive behavior is any conduct that hinders a medical provider’s ability to administer care, interferes with communication, has the potential to cause damage to property or is perceived as a threat by others. Disruptive behavior may include: 

• Derogatory statements
• Verbal threats
• Offensive gestures
• Sexually explicit comments or behavior
• Physical aggression or violence
• Tampering with property 
• Throwing things
• Stealing or attempting to steal medical supplies 

Some of the most common causes of disruptive patient behavior are long waits, feeling misunderstood or that health concerns are being minimized, unmet expectations, and poor outcomes following a procedure. 

When dealing with a disruptive patient, try to obtain information about what precipitated the patient’s outburst. If the patient is too agitated to communicate calmly, ask a staff member who was present if they know what happened. Keep in mind that the event that triggered the outburst is typically not the sole reason for the upset. Patients who become disruptive are often dealing with multiple stressors and the one that just occurred pushed them over the edge and caused them to lash out. 

A key strategy for dealing with disruptive patients is to address their emotions by showing empathy and finding a way to meet their needs. Allow disruptive or angry patients to appropriately express their feelings, and let them know that you hear them and truly want to help. Try to avoid telling patients they are wrong, as this may escalate their anger. Also try not to minimize the patient’s feelings with statements such as, “No one has ever complained before.” In many instances, this could escalate a disruptive patient’s anger. Let patients know that you and your staff care about them and are committed to taking steps that are in their best interest.  

If a patient continues to be disruptive despite your efforts to help, you may want to suggest that they come back another day. “I can see that this is upsetting for you. Perhaps it would be best if we end this visit and you come back another day to address the matter.”  

When responding to disruptive patients, remember that although the most identifiable emotion is usually anger, the root cause of the upset may be more complicated. Following are four circumstances that may be a factor for disruptive patients and suggested ways to address each. 

Chronic Pain 

Patients who suffer from chronic pain can easily become angry and disruptive. If the pain has been present for more than 6 months, they may feel the medical profession is “failing them” or “not understanding” how debilitating the pain is. Chronic pain patients are often grieving the life they had prior to the pain. They may have had to give up activities such as gardening, playing sports or going out with friends, leading to social isolation. They may also fear that the pain will never go away, and this may cause anxiety about the future. The psycho-social effects of chronic pain can create a perfect storm for a patient to lash out at a medical provider. 

You can show empathy for chronic pain patients by not minimizing the pain or telling them it’s all in their head. If you cannot offer much to alleviate their pain, help them find small ways to reduce their isolation, which will take their focus off the pain. For example, you might suggest that they get together with a friend for a shorter time than they used to and do something that won’t make their pain worse. By helping patients reclaim pieces of their lives they feel they have lost, you will show them that you understand how much the pain has affected them.  

When chronic pain patients ask for additional opioids and you have to turn them down, they may become disruptive. You can try to calm these patients by speaking softly and explaining why you cannot fulfill their request. Try to avoid making accusations that might cause patients to become defensive or hostile. If possible, offer an alternative medication or treatment such as physical therapy. You may need to refer them to a pain management specialist.  

Fear or Worry 

Fear and worry are common emotions that are often masked by anger. A single mom who is told she needs a complex surgery may worry about how she will care for her children and earn a living. A patient who is told he needs a hip replacement may fear he will lose his independence. Patients diagnosed with diabetes or other chronic conditions may fear how their lifestyle will be affected. When fear or worry is a cause of a patient’s anger, you may be able to reduce the anger by providing information about resources that can provide childcare or personal care during a recovery. Patients who are diagnosed with diseases that require lifestyle changes may benefit from attending classes and support groups where they can interact with others who are experiencing the same thing.  

Some people do not handle uncertainty well. If they are told that they need a particular surgery or procedure, they may ask a lot of questions and become agitated or disruptive. You can help your patients by telling them what to expect before, during and after a procedure. Keep in mind that a procedure that may seem like “no big deal” to you or some of your patients may be a very big deal to others.  

Feeling Unheard, Misunderstood or that Their Concerns Are Being Minimized 

Most patients come to your office with certain expectations. If they feel they are not being heard or that their concerns are being dismissed, they are more likely to become agitated and disruptive. One way to defuse these patients is to let them have their say and acknowledge that you understand and hear them. Some statements you might use include: “I understand that this is upsetting to you. What can we do to help?” and “If you can tell me why you’re upset, maybe we can find a solution.”  

Patients who self-diagnose using the Internet may become disruptive if you disagree with their “diagnosis.” You can reduce the potential for an upset patient by doing your best not to make the patient wrong. Allow them to share their “findings,” and after you complete your examination, explain your diagnosis and treatment plan and why you reached this conclusion. You might describe why the diagnosis they came up with does not fit. For patients who regularly try to self diagnose, you might provide a list of authoritative websites where they are less likely to find incorrect diagnoses. This list might include the Mayo Clinic, the CDC, The National Institutes of Health and the American Academy of Family Physicians.  

Unidentified Medical Conditions, Medication Complications or Psychiatric Disorders  

If certain patients routinely become disruptive and their behavior seems out of proportion to the precipitating incident, you may want to consider whether the patient has an underlying psychiatric disorder or whether a medication or medical condition might be causing the outbursts. These patients may also be having anger management issues at work or at home.  

The challenge in addressing these possibilities is that an agitated patient is not likely to respond well to such suggestions. It may be best to address the possibility at a time when the patient is not agitated. Then, you might bring up the subject in the form of a question accompanied by an expression of empathy, for example: “Have you noticed that you are easily angered lately? I know being angry probably doesn’t feel very good and may be hurtful to people you care about. Maybe we should explore whether a behavioral health specialist could help you find ways to cope with your anger.” Patients may initially resist this idea and insist that they wouldn’t get so angry if others would just “listen to me” or “treat me fairly.” Unless patients are a danger to themselves or others, you cannot make them get help. All you can do is present the possibility and allow the patients to reach a point where they can accept help.  

The root causes of an upset will not always fit into the four categories described above. Some patients may be naturally contrary and nearly impossible to satisfy. They may be inclined to get upset regardless of how much time you spend with them or what solutions you offer.  

If a patient becomes verbally or physically threatening towards a staff member or another patient, you may need to firmly ask the patient to leave the office. If they fail to do so, inform them that you will need to call law enforcement to escort them out. After such an incident, it may be wise to send the patient a letter explaining that your responsibility is to ensure the safety of your staff and all your patients. Let the patient know that you are willing to discuss the matter, but that outbursts such as the one that occurred previously will not be tolerated.  

Create a Policy for Handling Disruptive Patients 

You may want to establish a written policy for staff to follow when dealing with disruptive patients. This might include: 1) The staff member treating the patient attempts to calm the patient and lets them know their behavior is unacceptable. 2) The staff member obtains assistance from a manager to deal with a patient who remains disruptive. 3) The manager issues the patient a verbal warning that their behavior is unacceptable and must stop. 4) If a patient is repeatedly disruptive, the patient is sent a written notice that their disruptive behavior is unacceptable. The notice should describe the unacceptable behavior and the dates it occurred. Indicate the consequences if the behavior continues. 5) The circumstances under which law enforcement should be called (e.g., patient is throwing things, attempting to break into a locked cabinet or physically intimidating a staff member or another patient).  

Finally, be sure to document any incidents involving disruptive or upset patients. Objectively describe what occurred, what witnesses reported about the incident and whether the patient was successfully de-escalated or was upset when they left your office. Avoid making emotional or accusatory statements in the medical record. Also indicate whether staff members or other patients expressed concern for their safety due to the patient’s behavior. When a situation with a patient escalates to the point where law enforcement is called, be sure to document this and detail what occurred when law enforcement arrived. 

Sources 

Arshya Vahabzadeh, MD. KevinMD. 4 Reasons Why Patients May Become Angry. April 3, 2014. Accessed September 13, 2018. https://www.kevinmd.com/blog/2014/04/4-reasons-patients-angry.html 

How to Deal With ‘Problem’ Patients at Your Healthcare Practice. June 5, 2018. Accessed September 13, 2018. https://www.patientpop.com/blog/running-a-practice/patient-experience/5-strategies-for-dealing-with-problem-patients-and-when-you-should-let-them-go/ 

Kelli Blanchard, Healthcare Business Insights. Keeping the Peace: Considerations for a Disruptive Patient Behavior Policy. October 3, 2017. Accessed September 13, 2018. https://www.healthcarebusinessinsights.com/blog/revenue-cycle/keeping-peace-considerations-disruptive-patient-behavior-policy/