At the Feb 23 Internal Medicine Grand Rounds, representatives from across UI Health Care joined for a panel to discuss the sensitive topic of how to deliver care when a patient or their family members are disruptive. Disruptions can take a variety of forms of verbal or physical abuse, each requiring different responses.
Led by Poorani Sekar, MD, the first half of the hour-long session focused on the current landscape, including defining terms and the variety of challenges faced in clinical spaces. Sekar also detailed the various resources that exist at UI Health Care, from training how best to respond to the existing support that can be called in an abusive situation.
In the second half, a panel of experts discussed their roles and responsibilities and how they can help clinicians and staff who encounter tough situations or how they might be able to avoid them altogether. [Note: In the below recording, adult language and situations upsetting to some will be used and described.]
Recording:
Responding to Disruptive Patient Behavior
Presenter
Poorani Sekar, MD, Clinical Associate Professor in Infectious Diseases
Panelists
- Joseph Clamon, JD, Associate Vice President for Legal Affairs, University of Iowa Health Care
- Peter M. Berkson, Threat Assessment & Management, University of Iowa Hospitals & Clinics
- Lance Clemsen, MSW, Social Work Specialist, Department of Psychiatry
- Nicole Del Castillo, MD, MPH, Director, Carver College of Medicine Office of Diversity, Equity, and Inclusion
Following Grand Rounds, Sekar reached out to the panelists for follow-up and provided additional resources from her and them, some of which was discussed during the presentation and panel discussion.
- A work-in-progress smart phrase .bias that can be used in EMR notes. Instructions from Del Castillo on how to flag behavioral concerns on the chart: Documentation of Patient Misconduct Against Clinician (.pdf)
- A resident in Ophthalmology, Lauren Hock, MD, and some of her colleagues assembled and published a toolkit for responding to patient-initiated verbal sexual harassment. This includes a concise PDF here: https://webeye.ophth.uiowa.edu/eyeforum/tutorials/sexual-harassment-toolkit/Patient-Initiated-Harassment-toolkit.pdf
Additional resources:
Click image to view PDF
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| Title IX Resource & Referral Guide (.pdf) |
Office of the Ombudsperson (website) |
UIHC Threat Assessment Team (.pdf) |
Rave Guardian mobile app (pdf) |
Berkson also sent the below to Sekar:
Thoughts: If staff are fearful and having anxiety coming to work or even outside of work because of patients/visitors/staff who have made threats and/or are acting intimidating and aggressive, we would like to assist using a balanced and dignity preserving approach. I strongly believe that anxiety, and (often) unwarranted fear are diminishing the quality of our relatively short lives.
Information: Someone [during Grand Rounds] asked what is Threat Assessment and Management and I do not believe I articulated very well off the cuff a clear and palatable definition. Threat Assessment and Management is currently considered the Cadillac of research based violence prevention disciplines. The following definition is pulled from a reputable document called Making Prevention A Reality (pdf)
Threat assessment is a systematic, fact-based method of investigation and examination that blends the collection and analysis of multiple sources of information with published research and practitioner experience, focusing on an individual’s patterns of thinking and behavior to determine whether, and to what extent, a person of concern is moving toward an attack. A threat assessment is not a final product, but the beginning of the management process. It guides a course of action to mitigate a threat of potential violence.
Our thanks to Sekar and the rest of the panel for their dedication to this important cause and for taking the time during Grand Rounds and after to keep the conversation going.
