Throughout my years in private practice, I have encountered the occasional aggressive or angry patient. Rarely have I felt compelled to discharge someone because we could not defuse the situation and communicate with civility. Yet in the past year, I have dismissed 2 patients—not because of their interactions with me, but because of their rudeness and disrespect toward my staff.
The most recent incident is what compels me to write about this. In that situation, the aggressor wasn’t even my patient, but her husband. I was alerted when my technician came to me in tears after being confronted by him. To be fair, I understood their frustration: they were angry and confused, struggling to get their insurance company to approve a medication I had prescribed. Our records contained no fewer than 9 progress notes documenting the back-and-forth with the insurer.
When I entered the room, the husband’s behavior escalated. He became physically overbearing, and I was forced to ask him—firmly but respectfully—to sit back down. I then calmly told my patient of 25 years that I felt our relationship had reached its end. As the couple left, the husband continued his hateful tirade. The encounter left me shaken and kept me awake for nights afterward. My staff was equally distressed.
Sadly, this was not an isolated event. My staff and I are wrongfully blamed almost daily for the shortcomings of insurance companies: high copays, prior authorizations, and delays beyond our control. Some level of patient frustration is to be expected given today’s complex and confusing insurance landscape. But the escalation to aggression, especially when directed at staff, is alarming and unacceptable.
We work hard to train our staff to be compassionate, patient, and supportive. They even receive “active shooter” training, yet little preparation for how to handle hostile or threatening patients and their family members. What resources do we have for these increasingly common situations?
Fortunately, the American Academy of Ophthalmology provides guidance on their website (aao.org), including the following:
- De-escalate and Resolve: Mastering Upset Patient Situations
- Ask the Ethicist: How to End the Physician-Patient Relationship
- Termination of the Physician-Patient Relationship
- The AAO Code of Ethics and Advisory Opinions
- Additionally, the Ophthalmic Mutual Insurance Company (OMIC) offers detailed guidelines for managing difficult patients.
It is ironic—and disheartening—that in a profession built on trust and care for patients, we must now also protect ourselves and our teams from aggression and hostility. Yet it is essential. Preserving the safety and wellbeing of our staff is as much a priority as safeguarding the health of those who come to us for care. OM
