FFYFP Blog – “Spooky Situations in the Office”

By Dr. Charissa Ho

It is spooky season! With that, let’s talk about the scary situations we can encounter in our family medicine offices and how we can deal with them.

Spooky Situation 1: Upset patient in the clinic.

You’re going about your day when one of the MOAs knocks on your door.

Knock, knock.

 “Who’s there?” … “Scary situation!”… “Scary situation who?”….
 “Scary situation – someone is yelling at reception!”

Now what? If you remember any one thing from this blog post, remember this: REMAIN CALM!

In medical school and residency, we don’t get much (if any) training on conflict resolution. With increasing complexity of medicine and the lack of adequate primary care, many people are becoming increasingly frustrated with health care providers.

Unfortunately, verbal and even physical aggression are on the rise. As physicians, it is our job to ensure all clinic personnel and patients are safe. So, what are some practical things you can do on the spot to resolve this conflict?

1. Remain calm – that applies to your body language and your verbal language. Stand in a neutral position. Speak in a calm, lowered tone.
2. Give the person your full attention.
3. Acknowledge the person’s emotions/frustrations (“I understand/see you are frustrated”, “I’m sorry you feel that way”). Apologize if you or your clinic made a mistake. In some cases, it may be better to have a conversation in private.
4. Do not interrupt the person.
5. Work with your team and the person to solve the issue once the person calms down.

If you, your team’s, or patients’ safety is in danger, call for help – whether that is security available in your building or police.  Debrief with your team as soon as you are able to, much like we debrief after a code.

To help your clinic prepare for these situations, have a policy for harassment and aggression in clinic and have that information available for staff and patients. Review the policies and procedures with staff periodically so everyone understands how to deal with these situations. More commonly, patients are frustrated over the phone. Have a script/policy in place for when patients are being aggression over the phone as well.

Check out this summary from Registered Nurses’ Association of Ontario for more details on conflict resolution: https://rnao.ca/sites/rnao-ca/files/HWE_TipsAndToolsConflictR04.pdf

Spooky Situation 2: Medical emergency in the clinic.

You go in to see your next patient in clinic. The visit complaint on the chart says “cough.” Simple enough. You walk in and you see this patient tripod sitting on the chair, using all his accessory muscles to breath. When he talks, he can only get out one word at a time between his breaths. Now what?

We are all bound to deal with medical emergencies at some point in clinic. Remember the general rule? REMAIN CALM!

How do we practically deal with medical emergencies in clinic?

1. Remember the basics: CAB – cardiac, airway, breathing.
2. Get help – is there a colleague that you can ask for help? An MOA? Remember, you don’t need to deal with emergencies alone. Have someone get machines for taking vitals.
3. Use medications in your clinic or the patient has brought if they will help the situation.
4. Decide where this patient needs to go and how they need to get there. Do you call 911? Do you call RAAPID and ask for transfer/advice? Can someone drive this patient to higher level of care? Can the patient drive themselves to higher level of care? Ensure that the plan is the SAFEST plan. Unfortunately, safest does not mean most convenient sometimes. Your clinic may run behind, you may need to cancel some appointments. It is our duty to ensure the patient we are attending to has a safe and sound solution.

Remember, even if you are in a solo practice or happen to be the only physician in the clinic, you are not alone. Don’t be afraid to call for help. Familiarize yourself with your local resources. In Calgary, we have Specialist Link and RAAPID South. Throughout Alberta, any physician in any setting can access RAAPID for advice or transfers. These situations can feel very scary. Remain calm and solve the problem one step at a time. Make sure your patient, yourself and the clinic staff are safe at all times.

Spooky Situation 3: The List.

We have all been there. A 10-15-minute appointment booked for prescription refill. You review the chart, an anti-hypertensive and a lipid-lowering agent. Easy. You are starting the first patient of the day on time and feeling ready to go. You go in. In the patient’s hands is a list… Your stomach drops. You suddenly hear the clocks ticking louder than ever.

Tick. Tock. Tick. Tock.

How can you tackle this long list?

When in doubt, what do we do? REMAIN CALM.

There are different ways to approach “The List.” Ultimately, we know we cannot provide the attention and care each item deserves if we try to get through it all. Hopefully these tips can help you feel more prepared when The List comes in for a visit.

1. Set expectations. Let the patient know how much time you have today and what you can realistically achieve within that time. Let the patient know you want to make sure each item is addressed appropriately.
2. You have choices. You can either:  a) Ask the patient what are the top 3 things they would like to have addressed today. OR b) Review the whole list briefly and quickly figure out what is most important to address today.
3. Once the appointment time is near the end, let the patient know and ask the patient to book back in to address other concerns. Also let the patient know how much time you think would be required to address all the items in a safe and thorough manner.
4. Try not to go over time. This sets up patient expectations of: “oh Dr. So-and-so always goes through all my things”. Then you set yourself up for a practice of running late and more and more lists.

Final Takeaways – No Tricks, Just Treats

These are just a few scary situations from the office. In primary care, we know we encounter lots of scary things.

Remember:

• REMAIN CALM
• You can always get help – whether that is an MOA, colleague in person or on the phone, or ambulance. You are never alone.
• Be prepared. Prepare yourself for emergencies. Like we run through mock codes.
• Be kind to yourself. We may not be perfect every time we deal with scary situations. In fact, we likely won’t be perfect. We are human and sometimes we can be spooked. Try not to let these spooky situations get to you.

Have a safe and happy spooky season!

2 Responses to “FFYFP Blog – “Spooky Situations in the Office””

1. Excellent suggestions Charissa! I would also suggest that you have a plan at your clinics for how to deal with either an aggressive patient inside an exam room, and/or a medical emergency inside an exam room. Do you have a help button? Does your EMR have an emergency button? If you just yell out for help from within the exam room, you may not be heard, so figure out what other options will work for you.

   Reply

   • Great point Janet! Thanks for mentioning the clinic safety plan. Everyone is on board and know what to do in the case of an emergency

     Reply