Intended for healthcare professionals

Career Focus

Dealing with angry and aggressive patients

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7563.s64 (Published 12 August 2006) Cite this as: BMJ 2006;333:s64
  1. Karthik Vishwanathan, senior house officer
  1. Southport and Ormskirk Hospital NHS Trust karthik_vishwanathan{at}yahoo.com

Causes of anger

  • Long wait before a consultation

  • Receiving bad news such as terminal cancer or an unexpected death

  • Perceived delay in diagnosis or treatment

  • Patients may feel they have no options

  • Dashed expectations

  • Loss of control; people in powerful positions finding themselves dependent

  • Personality disorder, substance abuse, alcohol intoxication, and withdrawal or anxiety

Warning bells

Recognise them before things get out of control.

  • Voice—suddenly slow, soft or loud, boisterous, and abusive

  • Face—loss of eye contact; frowning; red face and red eyes

  • Physical—coming too close; sudden threatening movements in upper limbs

Do's

  • Keep a safe distance—neither too close nor too far

  • Stay cool, calm, and composed

  • Correctly acknowledge the emotion that the patient is projecting. Never mistake anger as anxiety or irritable behaviour

  • Acknowledge legitimacy, when appropriate, without blaming anyone

  • Listen actively by making good eye contact and nodding

  • Identify intensity of anger—“How angry have you been?”

  • Ask open questions: “What makes you feel so?”

  • Explore the reasons for anger and identify focus of anger

  • If complication is due to a surgical intervention, explain the options for treating the complication

  • Acknowledge imperfections of diagnosis, investigations, and treatment

  • Apologise, where appropriate

  • Finally, if all above options fail to work, take a break for some time, but do come back.

  • Assertive, non-aggressive communication about what is OK and is NOT OK is important

Don'ts

  • Interrupt a patient's or relative's outburst

  • Caution a rude patient for rude language

  • Deny reality, no matter how cruel

  • Talk to a patient from behind

  • Get angry, especially when the patient questions your credentials or competence

  • Challenge the patient's interpretation and criticise them for their reaction

  • Make defensive response such as, “We have been doing our best, don't you realise how hard we have been trying?”

  • Try to pacify them by touching them

  • Block their way ■

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