What should Doctors & Nursing Homes do, to Prevent &

Manage Violence by Patients/Relatives?

An Intern’s Skull Was Fractured By An Angry Mob
Dr Paribaha Mukhopadhyay, an intern doctor at NRS Medical college,
suffered a fracture on his skull after the mob threw bricks at him.
He is now reported to be out of danger but continues to be in the
intensive care unit.
That followed “nationwide protest” if the issue fails to get the
attention it deserves. We know very well what will actually happen.

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Anger often is either an expression of emotion
Derived from the patient’s situation & or triggered by minor lapse,
often unrelated….Patient’s PATIENCE is receding….

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Better to have cross verification mechanism…It
Matters…Empathy…Listen, Understand for course of correction

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 We can never win over an argument…
Better to diffuse early with all precaution….

Getting caught in altercation with One patient or family member can interfere with your
effectiveness as clinician & compromise care of other Patients too… 5
We never know Who is Who…Suffering What
Better to have rule in place without
discrimination…Empathy…Letting them know we are responding not
reacting or Arguing

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Acknowledge the Emotion & encourage to speak & Vent it out…

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Hospitalization can be intensely a devastating, destabilizing
experience for the Patient/Relative/ caregivers
…Physically/Emotionally/Financially…

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Patient’s sometimes feel their requests are unheard…
Expectations are not met?
Their conditions & concerns are not properly attended,
They were not informed about plan of management or decisions
made, risks involved if any?

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Empathetic…. Listening can be learnt for establishing
coherent
Dialogue & diffusing the situation…

Calmly respond don’t react….

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Anger…. Is Contagious
it can ignite Fight or Flight response in you …Calmly respond don’t
react….

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Diffuse…. it with Empathy ‘I can understand your situation’….
Calmly respond don’t react…. If necessity arises
Be prepared to call up Police….

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People Don’t care how much you know, until they know How
much you Care…

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Avoid being defensive…Lend a Ear to his/her concern…
Resolve if possible… Explain or buy out time to diffuse…

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Universal upset person protocol
Dr Dike Drummond
“Works for patients, colleagues, your partner, children & even
complete strangers”….
Regardless of what/who they are upset with, either verbally upset or
visibly upset, but silent

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 An angry patient is
unlikely to be receptive to
your explanation until his
grief is fully expressed….

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Patients Stories need to be heard careful listening is just
part of defusing the Patient’s Anger

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Our Curiosity about what has happened has therapeutic effect.
By Staying curious, we also avoid being defensive about ourselves.

Be Curious Not judgmental

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By arguing, trying to judge or expressing opinions, a power
struggle may ensue making things worse…

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Unfortunately… difficult patients & relatives continue to
exist…We can’t beat them or throw them out

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Unfortunately…
1. Errors will continue to happen however we have
to introspect & try to minimize.
2. Processes need to be followed sometimes
loopholes are there is our processes, change it.
3. Face it don’t run away.
4. Avoid being defensive or blaming others.
5. Acknowledge patients emotion with Empathy, spot
out the 1st main cause of agitation.
6. Establish trust & diffuse situation.
7. Learn from experiences.
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