Jennifer L. Higgins, MSW, LCSW, is a healthcare manager who serves as special assistant for Healthcare Resolutions at Brooke Army Medical Center in San Antonio, Texas. Reporting to the hospital’s chief medical officer, Higgins addresses adverse events, unexpected outcomes, and any quality-of-care issues between provider and patient. “I work as a neutral party to try to make sure that we don’t abandon our patients, but at the same time, our staff knows that they have rights,” she explained. Given the large size of the facility, deferring an unhappy patient to a different provider is a frequently used solution.
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November 2022Higgins noted that not every medical professional has the same level of conflict resolution/de-escalation skills, nor are they all able to exercise these skills 24/7, especially in the aftermath of an unpleasant or even threatening encounter with a patient. “I think with patients, empathy is the key, and really listening,” she said. “However, number one for a physician is figuring out where they themselves are emotionally. Ask yourself, ‘Am I in the headspace to have this conversation?’”
A hugely impactful yet often overlooked aspect to this issue is the shortand long-term effects on physicians, nurses, and other medical staff during or following abuse from a patient. Being the target of, witness to, or even close to an extreme event in which innocent people are seriously threatened, hurt, or killed is a recipe for psychological trauma. Prolonged harassment, in the form of ongoing online smears or other passive–aggressive actions, can affect a physician’s ability to perform their job optimally and may even discourage them from practicing clinical medicine.
Higgins recounted an incident in which a surgeon at Brooke was on the receiving end of hateful racial slurs made by a hostile patient. Understandably shaken and upset, the surgeon suffered a “lingering trauma” from the event, as “it reminded her of how hard she had to work because of people like that patient, and of the systemic racism that she deals with all of the time,” she explained. That physician took advantage of the Peer Support Program, co-chaired by Higgins and created to address the effects of adverse events on individual staff members and help them work through issues.
“Physicians are healers first, not police officers,” said Dr. Holt. “We are, by nature and training, compassionate and supportive professionals. Our first obligation is to understand the patient, why this attitude and behavior are taking place, and what can be done to alleviate any risk to the patient and others. Gathering the facts of the situation before seeing the patient is fair, as well as entering the room with a calm demeanor. If the patient is repentant and apologetic, it would be helpful to explain to them how their behavior was threatening and unacceptable, not conducive to a healthy medical environment, and that such conduct will not be tolerated in the future. Boundaries must be set, and it’s the physician’s duty to do so.”