Otolaryngologists Apply Safety Strategies When Treating Threatening Patients

“In our practice, violence prevention is approached as a system responsibility rather than an individual one,” Dr. Brenner said. “We rely on structured training for physicians and staff to recognize early warning signs, clear escalation pathways, and [we] have rapid access to institutional security. This includes pre-visit flagging when appropriate, standardized response plans, and clear guidance on when to disengage and involve trained security personnel. At the University of Michigan, these protocols are reinforced by institution-wide policies that emphasize early recognition, team communication, and prompt escalation to ensure safety for patients, families, and staff.”

The Ochsner Health System in Louisiana, where John Carter, MD, is system chair of otolaryngology–head and neck surgery, has a zero-tolerance policy for violence in the workplace. Acts or threats of physical violence, including intimidation, harassment, or coercion, are not tolerated. “If a patient is potentially violent, we have security in the clinic and on occasion in the exam room. Patients who threaten violence are alerted to the security team and our legal team. Physicians are also offered panic buttons to wear on their persons at all times to silently alert security if they perceive a threat. Any patients who exhibit violence are removed from the group practice, and law enforcement is immediately involved.”

Balancing Care with Safety

“We have a safety program that establishes procedural guidelines to identify potential security hazards and/or to mitigate security risk to staff, patients, and visitors,” Dr. Carter said. “While patient care is important, the safety of our staff, visitors, and other patients takes precedence.”

Staff safety is foundational to patient care, said Dr. Pandian. She highlighted practical strategies, including modifying visit logistics (e.g., room location, staff presence, and timing), ensuring security awareness or presence when indicated, and redirecting or rescheduling non-urgent care if safety conditions cannot be met. “This framing helps teams understand that safety planning is part of high-quality care, not a deviation from it.”

Dr. Brenner, using the aviation analogy of putting on your own oxygen mask first, said that “staff safety is a prerequisite for effective patient care. This also builds trust. Nurses, medical assistants, and front-desk staff are often on the front line, and they need to know that we as physicians and our leadership care about them and will step up to support them any time and every time that a safety concern arises.”

“Surgeons need to listen closely to their staff, who are often more attuned to early signs of escalating risk,” Dr. Brenner explained. “As surgeons, we are often focused on cognitively demanding tasks and technical decision-making, so we may miss behavioral cues that staff observe. Patients may also behave differently with staff than with physicians, sometimes directing threatening or intimidating behavior toward those they perceive as having less authority. These dynamics highlight the importance of team-based situational awareness and taking staff concerns seriously.”