How to prepare for and survive a violent patient encounter: Dr. YK Amdekar
M3 India Newsdesk Nov 21, 2019
Dr. YK Amdekar explains the stepwise duties of a doctor facing possible violence from patients or their families/relatives; also recounting a personal experience of how he handled a similar situation.
Before reading, take the poll below.
What constitutes violence?
WHO defines it as intentional use of force or power, threatened or actual, against oneself, individual, group or organisation which results in or has a high chance of resulting in hurt, damage, destruction or even death. It is an emotional outburst of destructive nature. It is an intentional use of physical force against an individual or a group or organisation. It is an act of power of one person over another.
Changing scenario of medical practice
Physicians of yesteryears commanded respect from the community to an extent that doctor’s views were sought not only for health issues but also in many other matters. The community had faith in their doctors as they witnessed how much doctors cared for them and the community did not care about how much doctors knew. Doctors showed concern with empathy as they communicated, counselled and stood by their patients in times of stress. Patients felt confident and had tremendous belief in their doctors. Things changed for the worst with rapid deterioration in doctor-patient relationship. It is a great irony that medicine is now often exposed to violence. It is a paradox.
Genesis of this change
Both doctors and the community have changed. There is a brutal dimension to medicine in that what is intended to heal may cause pain, damage or even death. Doctors often succeed but at times fail in their goal. Physicians don’t get pleasure in causing pain to their patients but their brains react to viewing pain less strongly than what patients feel. In fact, it is an adaptive response to be able to function effectively in the face of a patient’s suffering. This may blunt their response to a patient’s pain which may lead to confrontation, as doctors use harsh words, rudeness, authoritarian approach which could often be intimidating.
On the other hand, the community believes and expects that doctors should cure all problems. If the outcome is short of what is desired, it is seen as carelessness, negligence and the incompetence of doctors. With such a dichotomy of what doctors can deliver and what the community expects, irrational behavior of a few members of the community sets the stage for trouble that may escalate to any level.
How to avoid situations that may lead to violence?
- When a patient under your care does not progress the expected way, you must suggest to shift the patient to a better facility at the optimum time. A doctor must anticipate poor outcome even at the time when things are not looking so bad. A major problem arises when the patient is shifted too late and the doctor at the new hospital may loosely make a comment that the patient should have been brought before.
- In the hospital setting, doctors should be cautious to explain real situations in a manner that the seriousness is subtly conveyed. It is best to say that the outcome depends on how the patient responds and that will be known in the following days of hospital stay. In other words, the patient’s relatives should understand the seriousness and be prepared for an inevitable outcome. When this is not conveyed clearly, relatives start losing their cool and try to find mistakes and most often even bring up trivial issues such as not being allowed to enter the hospital as the security personnel was rude.
In such situations, one must maintain calm, be empathetic to the problems of the patient and relatives, and at the same time, justify the action that is in the interest of the patient. You must allow relatives to vent their frustration and anger, listen to them without interrupting and finally counsel them tactfully. It is the arrogance of a doctor that often sets up a problem; so learn to remain calm and confident.
- Another important rule is to allow relatives to witness care being taken within limits and spend time talking to them periodically. It often avoids trouble.
- Finally, let one doctor remain in communication as a spokesman so that there is no confusion created by too many people trying to convey the same message. It is at times conceived as opposing views and this becomes the bone of contention.
My personal experience
In a general hospital, a child was brought in an unconscious state and attending doctors had appraised the relatives about the seriousness and danger to life. However, the next day, when the child's health was sinking, a mob appeared in the hospital and started fighting with doctors and threatening them. Attending doctors anticipated a bigger problem and summoned me as a senior doctor.
The first step I took was to make all of them sit in a room and told them that I would listen to their complaints and find a solution. I allowed them to talk as much as they wanted. They wanted to know why the child was not improving despite correct diagnosis and treatment. So in their views, doctors were negligent and incompetent. As a lay person I thought they had a valid question.
Before answering their question, I asked them whether any of them was a teacher in a school and luckily, one of them was. I asked this teacher whether every student in his class scores good marks and passes. To which he said that not everyone passes, to which I told him that he is responsible for bad teaching. He immediately said that it was incorrect to blame him because he did his job well but a few children did not study, and so he is not responsible.
I explained to him that the same thing has happened in the patient's case. The treatment is correct but the child fails to respond. He understood my point and I requested him to explain it to the others. I waited and witnessed that the mob became quiet. This teacher told me that I should see whatever best could still be done and I promised him to monitor closely. Other doctors were surprised at how I could douse the fire within this mob so easily.
Takeaway
One must anticipate trouble and act in time to share responsibilities. Doctors must learn to avoid harsh words and rudeness that always fires back. We have to remain cool and not shout but explain in a way that a patient's relatives calm down. Force of any kind and/or authoritarian attitude leads to trouble. We must not forget that a failing situation results in inappropriate behavior of relatives and they need support rather than arguments. Doctors must follow what the previous generation of doctors did. They were good listeners, empathetic and caring. If one follows this rule, trouble can be avoided. Of course there has to be deterrent by law of such violence against doctors.
Disclaimer: The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
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