Patient Violence Against Physicians: What You Can Do

Leigh Page

Disclosures

April 30, 2019

In This Article

The Signs of Impending Violence

Battaglia identifies four arousal states in a potentially violent patient that you should look for, and offers some steps to deal with each one.

Fear. You may not be aware that some patients are even more fearful of you than you are of them. Even a petite nurse can make a big man fearful, so it's important to explain what you are doing: "I'm a nurse and I'm just going to take your blood pressure." If the patient tries to escape and you try to stop him, you're very likely to get hurt, so let him go.

Anger. When healthcare workers can deal with angry patients all the time without harm, they may develop a misguided sense of invulnerability and press forward. But when the patient gets red in the face and starts banging things around, it's time to retreat.

Confusion. Even elderly patients who are confused can be dangerous. A 100-pound elderly woman can grab a sharp object and incur a great deal of damage, such as poking out an eye.

Humiliation. Be aware that young men in particular may become violent as a way of saving face. Make a point of treating them with respect. Call them mister and don't use diminutive language.

Above all, Battaglia keeps talking to potentially violent patients. He remembers a big man who just got out of prison and was rearrested. "He was brought into the hospital by several police officers, and he looked very angry," Battaglia recalls. "So I said: 'I'm just a doctor. I just want to talk to you. You look like a very strong man.' The man said, 'Doctor, I'm not going to harm you.'"

Dealing With Verbal Abuse

A great deal of verbal abuse may be overlooked, such as cursing at the reception nurse during a long wait in the ED, but some verbal abuse needs to be dealt with because it can lead to violence. Battaglia says that the dangerous kind of verbal abuse is a threat of physical harm, such as "I'm going to knock you up against the wall."

The serious nature of verbal abuse depends on the comment, where it's said and who's being addressed, Butler says. "Many ED nurses are used to dealing with angry, mean people," he says. "They have a thick skin. But some of our newer nurses haven't developed that that yet."

Phillips says that physicians in the ED should step in and help out when nurses are being verbally abused. Patients are more likely to back down when facing two people.

Cooke has a similar recommendation. "The nurse should immediately get someone higher up to confront the patient with her," she says. "They both should let the patient know that our institution does not tolerate this kind of behavior. There is safety in numbers."

Talking with calm assuredness is the best way to handle a patient who seems potentially violent, Cooke says. Ordering tranquilizers or restraints is often not an option. Under Medicare rules, patients have to be "actively" or "imminently" dangerous before you can use these options, she says.

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