Why Abusive Incidents Against Physicians Are Rising and What Can Be Done about It

The first staff member a patient meets not only sets the tone for their visit and subsequent interactions but can also be trained to assess that patient and communicate any red flags to coworkers. “The initial intake impression of a patient or family can be very important to recognizing potential threats to the office personnel and other patients, as persons with pathological personalities often do treat staff differently than providers—at least at first. I consider this behavior to possibly be controlling and narcissistic,” said Dr. Holt, who added that the unpleasant behavior can either be professionally addressed with the patient or mentally filed for future interactions. “I have always requested that the intake and first clinical contact personnel apprise me of their concerns about any patient or family members before I enter the room so that I can plan an approach and potential series of responses should the interaction go awry.”

As a pediatric otolaryngologist, Dr. Gantwerker sometimes sees this phenomenon from the families of his patients. “If I learn that the family was out of line [with staff], I thank them for their patience but tell them that we are a team, and I would appreciate everyone getting the same respect that they give me,” he said.

“People see other entities making money from healthcare while their own costs continue to rise. They don’t necessarily see justice being done on their behalf. In response, some individuals empower themselves by taking matters in their own hands. —Eric Gantwerker, MD, MMSc

Dr. Holt supports conflict resolution education for all patient care personnel, who also learn what to do if those tactics fail, and contends that medical students should be taught appropriate responses to this behavior as well. However, given the limited power that students have in the clinical setting, “the responsibility for their safety rests with the institution and their supervising physicians,” he concluded.

Indeed, an argument could be made for teaching conflict resolution in medical school. “It’s an invaluable skill,” agreed Dr. Gantwerker. “However, the problem with medical education is always that if you add something, you have to take something away. But I do think everyone should be taught de-escalation skills, because in these times, you cannot wait for security or the police. Brazen people are too apt to take matters into their own hands.”

When a situation does spiral out of control, any attempt at resolution must give way to decisive action. “The physician has a duty to protect other patients, their families, and clinic personnel,” said Dr. Holt. “Persistent unruly or threatening behavior may require a decision to contact hospital security or local law enforcement.”