Dr Marika Davies, senior medicolegal adviser at Medical Protection offers the following advice:
During the consultation
This is a challenging situation which can adversely impact on the care you provide by distracting you from your patient, who should be the focus of the consultation. Sometimes relatives can be aggressive if they are stressed or afraid, so try to establish if there are underlying concerns that you can resolve.
If you are unable to do so, and their behaviour continues, it is entirely reasonable to ask the relative to leave the room so that you can concentrate on your patient. Understandably, your patient’s relative may not accept that approach. But you will need to politely and calmly explain that you will not be able to continue the consultation if they are aggressive and disruptive.
Sometimes, you may have no option but to end the consultation. If this happens, you should make arrangements for an appropriate follow-up of the patient, as you may not have had the opportunity to deal with their medical needs when their relative was present.
Keep a careful record of the consultation, and consider whether the behaviour of the relative raises any concerns about the welfare of the patient, particularly if they are a child or potentially vulnerable adult.
After the consultation, inform the practice manager about the incident. The practice manager can then follow up with a letter to the patient or their relative to advise them that staff must be treated with respect and that aggressive behaviour will not be tolerated. The manager can also offer a meeting to explore the underlying issues and try to understand the reasons for the behaviour.
Practices should display notices to inform patients of the kind of behaviour that is expected from them, and this can be discussed in more detail in person.
As a practice, frontline staff can be given conflict resolution training so that they have the skills to defuse potentially aggressive situations, for example by recognising the early signs of agitation, irritation, and anger, and using techniques for distraction and calming. NICE's guidance on dealing with violence and agression has recommendations on this.
If you know in advance that a patient or their relative may be aggressive, take steps to protect yourself by making sure that you have an exit strategy (i.e. the patient is not between you and the door) and that you are not alone in the surgery building.
A practice should not usually remove a patient from list because of the behaviour of a relative, but very occasionally it can be the only option if all efforts to improve the situation have failed and it is proving detrimental to the doctor-patient relationship.
Contact your medical defence organisation for advice if you consider this may be necessary or if the problem continues.
Photo: JH Lancy