Clinicians are not obligated to place themselves or their teams in danger for non-emergent care, explained Dr. Pandian. Institutional support for clinicians who step away from unsafe situations is essential to maintaining a culture of safety. “Termination of care, when necessary, follows established ethical and legal safeguards: documented rationale, written notice when appropriate, emergency coverage during transition, and assistance with referral or alternative care when feasible. These processes are handled at the organizational level rather than by individual clinicians.”
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April 2026Final Thoughts
One of the strongest lessons learned is that “managing threatening patients is a systems issue, not an individual failure. Clear policies, leadership engagement, staff training, and visible institutional support are what ultimately protect patients, clinicians, and staff while preserving trust in the care environment,” Dr. Pandian said.
Some injuries that can cut the deepest needn’t be physical. “Violence in health-care is often framed narrowly as physical assault, but this perspective overlooks a broader spectrum of harm,” Dr. Brenner noted. Neuroscientific research demonstrates that emotional pain activates neural pathways that substantially overlap with those involved in physical pain, underscoring that threats, intimidation, humiliation, and chronic verbal abuse can be experienced by clinicians and staff as injury.
“Non-physical violence in healthcare settings may include repeated verbal aggression, discriminatory or demeaning language, sexual harassment, coercion, stalking behaviors, deliberate noncompliance used to intimidate staff, or threats directed at team members or their families. These behaviors can create sustained psychological trauma, erode situational awareness, impair team communication, and compromise patient safety in ways just as deleterious as the effects of physical violence.
“While non-physical violence does not leave visible injuries, it often exerts a more insidious and enduring impact, accumulating over time and affecting morale, retention, and performance,” Dr. Brenner concluded. “Conceptually, these behaviors should be understood not as lesser offenses, but as closely related manifestations of violence that demand proactive recognition, clear institutional standards, and the same seriousness of response as physical threats.”
Katie Robinson is a freelance medical writer based in New York.
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.