A registrar survival guide ... Dealing with the aggressive patient

Contributed by Dr Pipin Singh, a GP ST in Northumbria

Understanding aggression: the patient's perspective
Aggression in a patient tends to be a manifestation of underlying emotion. These emotions may include fear, confusion and stress.

Aggression can be verbal, non-verbal and physical. It is important to understand why a patient may be aggressive.

Recognising aggression
It is important to recognise when a person is becoming aggressive in a consultation. Clues are present from before the patient has entered the room.

  • Has the record flagged the patient as potentially aggressive?
  • Have staff warned you about the patient?
  • Is there a history of physical offending?

During the consultation, note the patient's body language and eye contact. Closed body language with evasive eye contact may generate an uneasy atmosphere. This could be for numerous reasons but be aware of hidden aggression.

Note the patient's tone of voice. A voice getting louder with negative content is a sign of increased emotion. The use of foul language may indicate that a problem is emerging.

Dealing with emerging aggression
It is extremely important to acknowledge the patient's frustration and respond empathically. Empathic statements, if used appropriately, can be very powerful.

In addition, non-verbal skills such as open body language and good eye contact are vital.

An apology may be necessary. Do not be afraid to provide this if necessary, it is not an admission of guilt.

If your personal safety is at risk, ensure that you vacate the consulting room immediately.

It may be necessary to press the panic button. Ensure you know where it is and how it works.

Essentials checklist
  • A knowledge of the patient's notes prior to seeing them.
  • Knowledge of how to locate and use the panic button.
  • Alertness to a patient's non-verbal cues.
  • Ability to acknowledge the patient's frustration.
  • Empathy.

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