Dealing With Disruptive Patients and Building a Positive Practice Environment

By: Donna Nicholson, MBA, BSN, RN, CPCO
3 Minute Read

If you’ve noticed a rising number of patient complaints and disruptive incidents in your practice in recent years, you’re not alone. Across the U.S., hospitals and practices report higher rates of dissatisfaction and complaints among the patient population, despite their best efforts to provide high-quality healthcare services.

Understanding how to handle disruptive patients and family members while addressing complaints and concerns is necessary to create a positive environment where providers are able to deliver high-quality healthcare.

De-escalation Techniques

When presented with a threatening patient encounter, the most important thing that a provider can do is to try to de-escalate the situation. When physicians and staff recognize sudden tension or feel physically threatened by a patient or patient’s family member, we recommend the following:

  • Speak in a calm, soft voice when responding to angry or threatening assertions
  • Apologize when appropriate, acknowledging specific grievances (e.g., extensive wait times)
  • Avoid blaming others
  • Call a “time out” to provide the individual with the time and space they need to gather their thoughts

Unfortunately, these situations can sometimes spiral out of control, putting providers in immediate danger of violence or retaliation by patients or family members. In order to further protect physicians and medical staff, practices may also want to consider installing panic buttons to alert security of potential threats, providing training on how to handle violent or emergency situations, and using metal detectors at entrances to urgent care locations.

Why So Many Complaints?

While it’s important to know how to de-escalate threatening situations and protect staff, physicians and practice leaders should also explore the various contributing factors to a growing number of dissatisfied patients and family members.

Physician burnout is on the rise. This isn’t news. However, what we’re learning now is the ways in which this burnout impacts patients and practices. According to a study by the Stanford University Department of Psychiatry, physicians with high burnout scores had a strong association with the number of patient complaints.

When physicians feel overwhelmed or dissatisfied with their work, they are more prone to make errors or their interpersonal relationship skills may suffer.

Furthermore, in an era characterized by high-deductible healthcare plans, patients have grown to expect more from their physicians and from practice staff. Patients are now often expected to pay thousands of dollars on their healthcare up front, causing them to place undue blame on physicians and practice staff when they feel dissatisfied with their service.

You can read more about this phenomenon in my recent article, “Navigating Patient Experience in an Era of High Deductible Plans.”

Both of these factors significantly contribute to the rise in complaints and the growing issue of disruptive and disgruntled patients within the practice setting. By taking a proactive approach to managing care quality and patient expectations as well as providing physicians with the optimal environment for practicing medicine, it’s possible to decrease the likelihood of disruptive incidents.

What Patients Want

According to an interactive poll from the Wall Street Journal, the top five things that patients want from healthcare team members are the following:

  1. To be treated with dignity and respect
  2. To have their healthcare concerns heard and questions answered
  3. To work with providers that are easy to talk to
  4. To have their concerns taken seriously
  5. To work with providers who are willing to spend time with them

Interestingly enough, none of these top concerns actually addresses the medical services themselves, but rather the behaviors of physicians and other providers.

Understanding that these are the core factors that can drive patient complaints, we recommend that physicians and practice leaders encourage the following behavior among staff:

  • Be self-aware of behavior and performance when interacting with patients and family members
  • Take accountability and express concern when patients are frustrated
  • Recognize professionalism in action and encourage continued
  • Be willing to give and receive constructive collegial feedback

Curi members who would like to learn more about this topic can view our CME webinar “Promoting Safety, Professionalism, and Patient and Personal Satisfaction.” For further guidance on this issue, Curi members are also encouraged to reach out to our Claims and Risk Management Departments at 800.662.7917.



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Donna Nicholson, MBA, BSN, RN, CPCO
Donna Nicholson is Curi Advisory's Managing Director of Risk Solutions based in Raleigh, NC.

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