How to de-escalate troubling patient encounters

Physicians and their staff commonly face rudeness, anger, and toxicity when caring for patients. To handle these stressful or demeaning exchanges, here are four techniques to try:

1. Don't take it personally. Remember that hurting people hurt people. The root cause of their incivility may be stress, fear, fatigue, illness, ignorance, or a past experience of trauma or abuse. Acknowledging their hurt does not justify or excuse their bad behavior, but it can help reset your perspective on the situation so you can handle it objectively and professionally.

2. Take a timeout. Sometimes, patients’ emotions (or your own) are so high that you need to step away for a moment. Calmly acknowledge the emotions in the room, explain that you would like to start over, and then leave the exam room for a few minutes. When you return, shake the patient’s hand, introduce yourself again, and explain that you are there to help. This can change the tone of the interaction and give the patient a second chance to act in a civil manner.

3. Respond, don't react. People are going to say and do things that offend you. But instead of just reacting to the offense, stop and take a deep breath. Then, calmly respond in a way that is confident and direct, yet civil. For example, if a patient were to mock a physician’s accent, the physician could respond with, “I love my accent. It reflects the fact that I speak more than one language — a gift that allows me to connect with people of many backgrounds, enriching my life.” Such a response can disarm negativity instead of stoking it.

4. Check your feelings. Rising above a patient's rudeness or other toxic behavior takes inner strength, emotional intelligence, and self-control, which isn’t easy if you're feeling exhausted, hurt, or defensive. Take note of your feelings so you can identify what you need in the situation, whether that’s a moment to regroup or a colleague to take over the exam.

These techniques may not work on every patient. If you begin to feel unsafe at any point, leave the room and get help.

Read the full FPM article: “Incivility in Health Care: Strategies for De-escalating Troubling Encounters."