Effective strategies for de-escalating patient interactions in medical practices

Managing patient interactions can be challenging in medical practices, especially when tensions arise due to misunderstandings, billing issues or simply the inherent stress of medical care. Effective de-escalation is essential for maintaining a safe and supportive environment for both patients and staff.  

The following step-by-step strategies from Debra Bartel, FACMPE, practice administrator at Woodburn Pediatric Clinic in Woodburn, Oregon, provide advice on handling difficult patient interactions to ensure that situations are resolved calmly and professionally. 

1. Preparedness is key 

The first step in de-escalation is ensuring that your entire team is familiar with protocols for handling situations that may escalate beyond control. Regular practice and discussion of these procedures should be a part of your clinic’s routine, ideally conducted a few times a year. 

In the most serious cases, it is essential that everyone knows what to do if evacuation and/or calling 911 becomes necessary. Some practices even designate a staff member to preemptively call 911 to alert authorities of a potentially escalating situation. Understanding the typical response times for law enforcement or first responders at your location is crucial. In today’s climate, being prepared for any eventuality is a must. 

2. Calm introduction 

When encountering an agitated patient, a calm demeanor can make a significant difference. Approach the patient with a smile, introduce yourself and offer to discuss their concerns in a private area. This not only helps in isolating the situation but also conveys that you take their concerns seriously. 

3. Private discussion 

Move the patient to a separate area — an exam room is ideal — where you can have a more focused conversation. Keep the door slightly open and ensure that another staff member is nearby in case assistance is needed. This approach provides a balance between privacy and safety. 

4. Active listening 

Once in a private setting, reintroduce yourself and invite the patient to explain their concerns. Active listening is crucial here — maintain soft eye contact and avoid interrupting. If the conversation veers off-topic, gently steer it back to the matter at hand. This shows respect and helps you understand the root of their concerns. 

5. Clarification and paraphrasing 

After the patient has finished speaking, paraphrase their concerns to ensure you have understood them correctly. This vital step demonstrates that you are fully engaged and committed to resolving the issue. It also allows the patient to clarify any points, if necessary. 

6. Apologize and offer solutions 

Regardless of whether the patient’s concerns are justified, an apology for the situation is always appropriate. If you can resolve the issue immediately, do so. If not, ask the patient how they would like the issue to be resolved. If their request is feasible, act on it promptly and inform them once the issue is resolved. 

7. Handling unreasonable requests 

There will be times when the patient’s request is something you cannot fulfill. In these cases, explain why the request cannot be accommodated and offer an alternative solution. This approach demonstrates empathy while maintaining the boundaries of what is possible. 

8. Thank and follow-up 

Conclude the interaction by thanking the patient for bringing their concerns to your attention. If appropriate, provide them with your contact information and encourage them to reach out directly if they encounter similar issues in the future (especially if the issue was caused by the clinic).  

If the problem can be addressed through staff training, inform the patient that steps will be taken to avoid future issues. In many cases, concerns arise from billing misunderstandings; assure the patient you will check the billing system to identify and correct any errors. This personal touch can go a long way in rebuilding trust. 

9. Addressing escalation 

If a patient refuses to follow instructions and continues disruptive behavior, it is important to take control of the situation. Firmly but respectfully inform them that such behavior is not tolerated in the clinic. If the situation does not de-escalate, have another staff member call 911 and begin evacuating other patients from the area. In a hospital setting, calling security is typically quicker and more effective. 

10. Post-incident documentation 

After the situation has been resolved, it is crucial to document everything that transpired. Have all staff involved write down their observations, as this information will be necessary for filing a police report or informing security. Accurate documentation ensures that your practice is protected and that all steps were taken to handle the situation appropriately. 

11. Continuous learning 

To further enhance your team’s ability to manage difficult situations, consider utilizing online resources and training programs.  

• MGMA’s Ed Plus includes front office training courses on dealing with disruptive patients, controlling healthcare workplace violence and keeping your workplace safe. 
• Texas State University’s Advanced Law Enforcement Rapid Response Training (ALERRT) offers excellent tools, including free online courses, that can prepare your staff for de-escalation and emergency situations.  
• Read MGMA’s article, “Addressing workplace violence in healthcare settings,” for specific issues around building an emergency action plan and developing security policies. 
• MGMA members have exclusive access to the emergency planning checklist, as well as the annual compliance training checklist. 

Conclusion 

De-escalating patient interactions requires a combination of empathy, active listening and preparedness. By implementing these strategies, your medical practice can effectively manage tense situations, ensuring the safety and satisfaction of patients and staff. Regular training and preparedness drills will keep your team ready to handle any scenario, fostering a professional and secure environment for all.