Unfortunately, in the course of providing health service to patients, you will encounter many patients who behave in a way that makes you feel unsafe or uncomfortable. Inappropriate behaviour can include being rude, aggressive, sarcastic, disinhibited, making suggestive comments, and touching sexual body parts. It is important to develop a professional approach for navigating such situations. Your health service leader (e.g. a senior nurse manager) should also be able to guide you on this. This article provides an introduction to some techniques you can use when dealing with inappropriate patients.

Why is the patient behaving this way?

It is important to address why the patient may be behaving inappropriately. Inappropriate behaviour may not simply be due to just “immature” or “childish” behaviour (however, if a senior nurse/doctor is fairly confident that this is the reason, and if the patient is not experiencing any severe illness that requires prompt treatment, this may be the time for you to call security and have them shown to the door!). There are several reasons why a person may be behaving inappropriately.

One is that the patient may feel resentful about how they have been treated during their time at your health service. Has he waited for a long time to see you? Does she feel like you are not taking her seriously? Resentful patients may be uncooperative, rude and hostile.

Approach this situation by acknowledging what they may have been through (e.g. apologising sincerely for the wait, explaining why there is a long wait time, or asking if they require immediate medication for any pain they may be in), and show that you are actively listening to them (e.g. “I can see this must be worrying you”). Demonstrate that you are interested in their account of their symptoms and opinion as to what is going on (e.g. “Tell me more about that”, “what do you think might be the cause of this?” etc.).

Some patients may simply have significantly impaired judgement and inability to know how to behave properly and within polite social conventions. This may be due to a medical, neurological or psychiatric problem (e.g. certain medications, infection, schizophrenia, alcohol/drug withdrawal, brain tumours). If this is the case, you will need to be patient.

Always remember that becoming angry with the patient is most likely going to make the situation worse. Behave as professionally as you can, avoid engaging with socially inappropriate comments made by the patient, and as with all patients, focus on doing your job and provide thorough explanations for the medical condition or situation at hand. Focus on figuring out any underlying medical reason for their inappropriate behaviour, and provide the appropriate treatment.

Is there a motive behind their actions?

Some patients may have additional motives for seeking treatment (e.g. work compensation claims, or seeking addictive pain medications). They may attempt to misrepresent their symptoms – it is down to you and the doctor to take a thorough history and examination in order to get an accurate picture of what is going on with the patient.

They may also attempt to manipulate the situation through inappropriate behaviour such as by making personal comments and flattery. In no way should you respond warmly to this – it is crucial to maintain professional detachment in such cases. For some patients, it is worth outright telling them that “I am your nurse/doctor, not your close friend, it is not appropriate for you to speak to me like that”, “let’s just focus on discussing your symptoms”. Don’t be afraid to set limits as to what will and will not be tolerated in your health service. And if the patient is the opposite gender to you, it may be better to pass their care onto a co-worker with the same gender as the patient.

Involve your colleagues

If you have reason to suspect beforehand that your patient may behave inappropriately, always try to involve another health clinician. A male doctor/nurse, for example, should always try to avoid seeing a female patient by themselves if there is any possibility of inappropriate behaviour or examination of private body parts. Bring along a female co-worker as a chaperone/witness.

And if you are worried that your patient may be aggressive or dangerous in some way, bring another co-worker in with you, or let them know that you will be seeing the patient, and in which room, so that they can keep an eye on the situation. For the most unpredictable, potentially hostile patients, it may be worth calling for security guards and having them present, even if just to stand in the background, ready to offer support if needed.

When a line has been crossed

Finally, if a patient has inappropriately assaulted you (including emotionally, physically or sexually) – do not pretend it didn’t happen. Always report such situations to your senior. If the patient does not have a medical problem that causes impaired judgement (i.e. they are deemed “competent”), they may be legally prosecuted for their actions. For yourself, seek out a time to debrief on the situation with someone, and seek support and counselling as needed.


Sources:

• RNL
• Clinical examination: a systematic guide to physical diagnosis / Nicholas J. Talley, Simon O’Connor. 6th ed. Elsevier Australia, 2010.