- Posted Wednesday April 10, 2019
How do we deal with the barrage of aggression and anger from our patients? I ask you that question based on an altercation that a receptionist at my practice was party to a couple of weeks ago.
This wasn’t anything unusual but really made me stop and think about how we can protect our frontline staff, and how we can influence the behaviour of the minority of patients who treat us so badly.
Taking abuse from the people you are trying to care for
The team member in question works on minimum wage, so £8.21 an hour by April 2019 values. I’ll say that again, we pay our receptionists minimum wage - the same that you would get as a waitress, a care assistant, a cleaner... Are people working in those jobs subject to the hostility, the anger and sometimes violence of the people who they are actually there to care for? I think not.
We often have no choice but to put them in this position; sometimes they are isolated, working away from the GPs and other administrative staff. We are encouraged not to have glass screens, and we don’t want to disengage with the 99% of our patients who would never dream of behaving in such a way. We might give them a panic button or an alert function via our clinical system, but they don’t use them because they are now almost immune to this behaviour.
They know which patients are going to “kick off”, they prepare themselves, they are ready for it. Does this in itself change the way that the receptionist deals with the patient in question? Is it any wonder that many are often perceived as being impersonal, insensitive or intrusive?
How can we support our reception staff?
So, what are the solutions? Reminding our teams that these patients are the minority and getting them to work through how to deal with these situations and helping them plan their responses through roleplay may be a solution. How about sharing all of the positive comments that we receive and using them to try to balance out the dire behaviour of the few?
We could also ask our PPG or patient groups to help us working towards solving this behavioural problem. Having them in the waiting room, working with us, changing the atmosphere and acting as a positive influence on the poorly behaved minority.
How about creating a charter - sharing behavioural expectation for both sides, showing how the relationship should be conducted? It could include details of why we ask certain questions, and why we sometimes can’t do exactly what the patient wants.
An additional worry for me is working out how to resolve the issue of having to remove people who act in this terrible way, I know that they will go to another practice and without doubt behave in exactly the same way. That’s the problem - do we give them a second chance and try to work with them on their anger and behaviour, or do we pass them on and vow never to register them again?
Working on possible solutions with our peers
When we start to work more closely with the local practices in Primary Care Networks, will we be able to work differently, sharing our knowledge and developing strategies with other practices to solve the problem of abusive patients?
Unfortunately, I don’t think this is something that we can solve easily - in the moment, the removal of the violent, aggressive and abusive patient is the only solution and the only way that we prove to our team that we have their backs.
Should I pay the receptionists more? Historically many administrative staff have started on reception and then been promoted into new roles, but is that the right way around? Isn’t working on reception in some senses the most important and highly skilled role in General Practice?
The things that really matter
Maybe that’s one of the things for us to think about moving forward - without receptionists our patients won’t be seen, prioritised and cared for on their initial contact with our practices. Our clinical team won’t be supported in everything from having access to a chaperone, to a cup of tea after a particularly difficult consultation.
Perhaps the revolution that will make the most difference to primary care is to value and pay the frontline staff, the medical receptionists, what they deserve for the jobs they do.
First Practice Management members can download a sample Violence and Aggression Policy now by heading to our Policies and Procedures Library.