Otolaryngologists Apply Safety Strategies When Treating Threatening Patients

Surgeons have an obligation to provide appropriate care, but that duty is not unlimited. “When credible threats are made, the standard shifts toward ensuring safety while facilitating continuity of care through appropriate channels,” Dr. Brenner explained. “This may include transferring care to another provider or setting, involving risk management, and documenting the rationale for any limitations or termination of the physician–patient relationship. Patient abandonment must be avoided, but care does not have to be provided in unsafe conditions. We are fortunate to have an excellent office for patient safety and clinical risk that can help us navigate such situations and ensure clear communication with patients.”

Documentation and Communication

“In all matters of patient care, documentation should be factual, objective, and free of judgmental language. Behaviors, statements, and actions should be recorded, rather than interpretations or speculations on motives. Internally, communication should ensure that staff are aware of safety plans and escalation pathways while maintaining professionalism and confidentiality,” Dr. Brenner said. “Clear documentation also supports institutional learning and quality improvement efforts. If I have a conversation with the patient that addresses acceptable behaviors and interaction with staff, then I will often document that conversation in the medical record.”

Protocols should be in place for documenting and communicating about these patients internally. Dr. Carter suggested that a “practice needs to document and maintain records clearly with both their legal and patient advocacy teams. The security team needs to have knowledge of patients who exhibit behaviors that are at risk of workplace violence.”

Dr. Wei finds it helpful to reach out to the hospital’s legal team for guidance when in doubt about how or what to document. She suggested that it’s essential to “document facts, no narration or emotions, and state events clearly, [along with] who was involved, witnesses, what was said by patient/caretaker, our responses, what we did to de-escalate, and also document next steps and options for clinical care for the patient.”

“We also need to protect and alert our own teams,” Dr. Wei said. “I recall joining a daily 8:30 am huddle to share with our nurses, audiologists, and office administrative leaders about potential risks and threats for any individual so that they are aware, and if the patient/ family self-schedules an appointment with another provider, everyone is on alert.”

Reporting fatigue can occur when frontline clinicians, particularly ENT nurses and respiratory therapists, invest substantial time in documentation and reporting but do not see resulting changes in practice, staffing, or policy, Dr. Pandian said. “Over time, staff may disengage from reporting not because risk has resolved, but because concerns are not visibly addressed. Institutions that manage this well close the feedback loop by communicating outcomes, acknowledging staff input, and demonstrating concrete actions such as protocol revisions, added security support, or leadership presence.”