Dr. Pandian co-authored a 2024 qualitative study that explored the challenges with reporting violence against healthcare workers in the emergency department. “Strategies such as integrating reporting mechanisms into the health record, creating nuanced definitions of reportable events, and consistent education with positive feedback can promote reporting by staff. These efforts should be combined with prevention strategies to ensure we are collecting correct data about the success or failure of these programs,” the authors concluded. (Int Emerg Nurs. doi:10.1016/j. ienj.2024.101500).
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April 2026Psychological Profiles and Triggers
“No single psychological profile predicts violent behavior,” Dr. Pandian noted. “Common contributing factors include untreated mental health conditions, substance use, cognitive impairment, high emotional distress, perceived loss of control, and dissatisfaction with prior care. Operational stressors such as long wait times, complex care pathways, and poor communication are frequent triggers and represent modifiable risk factors.”
In otolaryngology, triggers may also include unmet expectations around surgical outcomes, chronic pain, intractable tinnitus, communication disorders, or underlying neurologic or psychiatric conditions. “Many patients are experiencing distress,” Dr. Brenner said. “Long wait times, perceived loss of control, and fear related to illness can amplify frustration and, in some cases, lead to threatening behavior. When a patient assumes an adversarial stance, rather than working together, the risk of violence increases.”
As a pediatric otolaryngologist, Dr. Wei finds that the most common scenarios of threatening demeanor or difficult adults tend to be couples who are in the middle of a contentious divorce or have been divorced and are using children as leverage in their fight with one another. “Often they each provide a different history; one is adamant about wanting surgery while the other is strongly opposed.”
Most experienced clinicians know within moments into any encounter if there is unusual tension or body language between two adults and/or between the adult and the clinician, Dr. Wei said. Conversations or communication with patients/families can escalate quickly. “I have had an experience where I had to quickly disengage. A father started raising his voice, stating on the phone that I best get an attorney. That’s the moment to stop interacting and ask for help and document,” she said, highlighting that patients can access these notes.
De-Escalation Strategies
“De-escalation is now a training module for every employee, it seems, just as quality and safety training is,” Dr. Wei said. “De-escalation should be a ‘team sport,’ not based just on any individual surgeon or physician or team member.”
A marvelous review with excellent suggestions.
To relate a brief episode: I was the only ENT in my county. We were 150 Miles N of Portland Maine with no oral surgeons (although I had been doing all the fractured jaws for years). We had a patient on whom I was very familiar, having done a mastoidectomy on him several years previously. He was in the ER having suffered a (well deserved) fractured jaw. He was yelling at the nurses and grossly threatening. I stepped in and having reviewed his Xrays demonstrating a simple jaw fracture. I met with him, rubbing my jaw and explaining that his fracsture was QUITE SEVERE and WAY BEYOND MY EXPERTISE!! (which it was not). So instead of referring him to the oral surgeons 45 miles South, there was no way that I would send him to some of my friends, So I sent him the the EXPERTS in PORTLAND, MAINE 120 miles south. So thus he could have all the expertiese of the residents on call.