We improve most by our mistakes.
When our integrity or competence is called into question, even by someone we do not know or care for, we take it seriously, and we feel it personally.
Part of the duties of a doctor is to talk with their patients over the phone. Phone calls at a practice should routinely be recorded as abusive patients may otherwise either deny or misrepresent what was said. Recorded calls may also be valuable to listen to following an incident as the doctor and a colleague assess how the exchange unfolded, and whether anything could be learned from the exchange, or handled differently.
At times the doctor experiences a difficult conversation with a patient who is frustrated with their treatment. The patient may talk loudly and quickly, and demand to talk for extended periods of time until their concerns are resolved. These patients, while difficult, do not intend to be hurtful, and it is important that the doctor distinguishes them from abusive patients.
Abusive patients are personally insulting and will not pause to listen to the doctor’s response. They may threaten the doctor with legal action, use inappropriate language, repeatedly curse, try to belittle the doctor, or threaten the doctor’s personal reputation and safety. A clear sign of an abusive patient on the phone is that they are not interested in working towards a solution to the issue they raise as their primary purpose is to vent their anger at the doctor.
When the doctor realises they are talking to an abusive patient rather than a difficult one, their first effort should be to discover whether the patient's behaviour has been brought on by a medical condition, a long wait, or whether their treatment has been under resourced. This provides context to the patient’s anger and abuse so the doctor can attempt to reply.
If the patient refuses to listen to the doctor, the doctor should work towards ending the conversation promptly, rather than attempt to find a solution.
The phrase “sticks and stones may break my bones but names will never harm me” was introduced as a way for children to respond to those who taunted them with insults and name calling. In truth words do harm. What our friends say, those we love, work and play with say, what those we despise say, and what complete strangers say all leave their impact, even though at times we pretend they do not.
We improve most by our mistakes. When our integrity or competence is called into question, even by someone we do not know or care for, we take it seriously, and we feel it personally.
As professionals working with people every day, a skilled doctor chooses their words, and equally importantly their tone, with great care. This is in direct contrast to the abusive patient who tries to provoke, shame, and threaten the doctor with their choice of tone and language.
Most difficult conversations doctors experience arise because they are denying a request of some kind from a patient.
Several responses follow that could be used when a patient repeatedly swears, or uses racist, sexist, or other bigoted language at a doctor:
“Excuse me, I can work with you to find a solution, but I do not work with people using abusive language. Please take a breath and start over.”
“Excuse me, I need to make you aware that all calls are monitored in our practice. Please start again and take more care with your choice of language. How can I help?”
“Excuse me, I can handle the problem, but I do not respond to anyone using abusive language. Taking care over your language, please tell me again what the problem is.”
“I am going to interrupt you to ask you stop using abusive language so we can work to find a resolution. If you continue to be abusive I will end this call.”
“I would rather find a solution to the problem than end this call, but if you continue to be abusive I will have no choice but to bring this call to a close.”
The treatment room is a place of control. The patient enters a less familiar space, and greets
If a doctor judges a call is abusive they should always report it to the practice manager with a note of the patient’s name, the date, and duration of the call so that a record is kept of the offence. Some patients may be repeat offenders who, for medical reasons, remain on the practice register, and their calls may therefore need to be directed to a doctor with specialist training.
An abusive call can be anything from unsettling to deeply upsetting, and its fallout can have a lasting impact. Following an abusive call it is therefore important that doctors take a moment to care for themselves in order that they best continue their duties. This may include taking a few moments of quite reflection, a short break for a change of scene, or confiding with a colleague about the call. If the abusive call continues to play on the doctor’s mind they should seek further support rather than keeping it to themselves.