Customer service and crisis prevention

Techniques to de-escalate patient issues


Years ago, at my previous practice, I experienced a scary situation with a patient. At the end of a long day, my staff informed me a patient in the lobby refused to leave without “talking to the person in charge.” As the chief operations officer, that was me.

When I arrived in the lobby, I found an agitated man on a medical scooter. I identified myself, and asked if I could assist him. He angrily informed me his eyes had been dilated during his exam, and he did not feel safe driving home. He then launched into a string of curse words, colorfully describing our office, doctors, and staff. Without knowing the background or nature of his visit, I explained how sorry I was that he was having this issue. If he could give me a moment, I would look at his chart and talk with the doctor.

When I pulled up his chart on the EHR, I realized he had been seen at 9 a.m. and dilated at 9:25 a.m. Unless he was having an adverse reaction to the dilation drops or had light sensitivity issues, he should have been able to use dark sunglasses and drive away immediately following his exam. Now that it was after 6 p.m., the dilation drops should have worn off several hours ago. In his chart, I also noted an addendum from one of the doctors: “Patient states he is unable to drive home due to light sensitivity from dilation drops. Pupil check completed at 3 p.m. Pupil function appears normal. Advised patient that dilation drops typically wear off in a few hours, and he could drive home at his convenience.”

I then tried to find the doctor, but quickly realized he had left for the day. Fully up-to-date on the situation, I went back to the lobby. When I approached him, he seemed more agitated; he was driving his scooter in circles around the waiting room chairs, with his behavior suggesting he was losing control. At that moment, I switched from “customer service” mode to “crisis prevention” mode, with the goal to have this patient leave our premises.

My training allowed me to de-escalate this patient. Below are the ways I tried to calm him down and defuse this scary situation.

Showed empathy and remained non-judgmental

While this patient’s behavior seemed weird and irrational, I focused on his feelings about being insecure to drive home. I ignored his cursing, instead trying to understand why he felt it was unsafe for him to leave our office. While I did not understand his rationale, his feelings were very real to him and were causing him to act inappropriately.

Respected personal space

Because he seemed agitated, I stayed several feet away from him, even when he stopped driving his scooter in circles. By giving him personal space, I ensured my presence — standing while he was sitting — did not seem threatening.

Watched my body language

I also kept my voice calm and did not use any hand gestures. My goal was for him to see me as someone trying to help him. I could tell he was having difficulty listening to words, so I tried to have my body language reassure him.

Ignored challenging questions.

During our exchange, the patient asked me several questions to challenge my authority in the office: “Why did the doctor send out a woman instead of seeing me himself?” “What kind of place are you people running here?” “What are you going to do about my problem?” While I could have responded to his interrogation, I decided not to answer him. He was trying to bait me into an argument and take us away from the issue at hand — his need to leave our office. Instead, I focused on what we needed to do so he could get home that evening.

Established limits

As our exchange lengthened, I realized this patient was not going to leave our office. Knowing I needed reinforcements, I texted the doctor who had just left our location. Thankfully, the doctor was not too far away and came back to the office to assist me. Together, we established options and limits for this patient’s behavior.

To do so, we clearly indicated the patient could not stay. Our positive options included alternative means of transportation home, allowing him to come back and get his car in the morning. He could also wait until he felt safe to drive but would need to vacate our building; we recommended a coffee shop next door. Our negative alternatives included calling the police to have him removed from our premises. Whichever option he chose, he was given simple and enforceable instructions that he needed to leave our office.

Achieved a peaceful resolution

Eventually, the patient left our practice, and the doctor and I locked the door behind him. He stayed in our parking lot for a while, but then finally drove away. The next day, we worked with our malpractice carrier to discharge the patient from our practice. I am thankful that my customer service training kicked in, I had a great doctor who responded to my need, and we were able to resolve this situation peacefully.

Though my story is extreme, as ophthalmic professionals we deal with patients every day who have the potential to become upset or angry. We can help reduce a patient’s anger by offering the client clear, consistent, and kind customer service. OP