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If you worry about becoming the victim of violence as a doctor, you’re not alone — according to a recent Medscape report, 43% of doctors surveyed felt not at all or only slightly protected from physical attacks at hospitals and healthcare organizations. And 61% of physicians working in medical offices said that physical security is more important today than it was just 3 years ago.
While many healthcare organizations have focused on spending more money on security measures designed to prevent violence, the ability to de-escalate patients may be one of the most effective tools to protect the staff.
About Medscape Insights
Medscape continually surveys physicians and other medical professionals about key practice challenges and current issues, creating high-impact analyses. For example, the Physical Security in Medical Workplaces Report 2026 found that:
- 16% of physicians surveyed said they were not protected at all from an attack at work.
- 32% of staff at a medical office reported their workplace had a security officer.
- Only half of physicians working in a medical practice said that they have been trained in incident response.
Heightened Emotions, Heightened Responses
The threat of violence is always on doctors’ radar now, said Jeff Goodloe, MD, emergency physician in Tulsa, Oklahoma. “There is an increasing tension in our society. It’s unmistakable, and unfortunately, that tension carries over into the emergency department [ED],” Goodloe told Medscape Medical News. “Patients are stressed, their families are stressed, their loved ones are stressed. They are presenting to the ED with acute pain or sudden injury…it’s already a heightened emotional situation that brings somebody to the ER [emergency room].”
It’s not only ED physicians who see patients who are frightened, stressed, in pain, or overwhelmed by their symptoms and concerns, however. Whether you work in an office or hospital setting, you will likely encounter patients and family members who can be angry or hostile.
Doctors and healthcare staff who fail to respond appropriately to these emotional states can easily make the problem worse, said Edward Wright, MD, board-certified emergency medicine physician who owns freestanding ERs in San Antonio. “Healthcare itself is a very inconsiderate system,” said Wright. “People in healthcare, for the most part, aren’t outright rude to patients, but they have almost zero consideration for what patients are going through.”
Patients are worried, stressed, and concerned about the cost. They may have moved heaven and earth to take time off work, find childcare, make their appointment times, travel long distances, and wait a long time to be seen. The aggravations of the system are numerous.
De-escalation Starts With Listening
Staff can unintentionally escalate patients by saying things like “You need to be quiet/you need to sit down/you need to shut up,” agreed Scott Zeller, MD, vice president of the multispecialty practice Vituity and assistant professor of psychiatry at the University of California, Riverside School of Medicine. “People don’t like to be told those things. The core of all de-escalation is listening — active listening and trying to determine what’s causing that person’s distress,” said Zeller. “Often people will de-escalate simply because someone’s given them a chance to say what’s making them so mad.”
Assess the patient. Tuning into your patient’s emotional state can help you begin to defuse a tense situation. Assess the person’s tone of voice, volume, facial expression, and body language. Do they seem agitated? Could you hear them yelling at the nurse in the hallway or the receptionist up front? “As soon I walk in the room, I can usually tell if someone’s emotional or scared. I will smile and say something like, ‘How are you doing — you seem really worried. What’s going on?’” said Wright. Tailor your response to the patient and the situation and keep in mind that the person likely feels frustrated or scared, even if it’s coming across as angry.
“Typically, I find that the patients are upset with the situation, but as the doctor, I’m the face of it,” said Goodloe. “You want to attempt to de-escalate within seconds of encountering the patient…finding a way to acknowledge and agree with a patient may successfully de-escalate the situation.”
Look for ways to agree with the patient. You probably can’t give a patient everything they want. But you can find ways to acknowledge what the patient is experiencing. For example, if a patient says, “I need morphine,” you might say, “We have state laws that tightly regulate those drugs. Let me see if we have pain medications that will work,” said Wright.
“Don’t challenge people about what they say,” agreed Zeller. “Don’t interrupt. Find ways to agree with them, even if you disagree with what they’re saying. Find common ground.” Arguing or needing to be right with a patient will likely make the person angrier or more frustrated. “You can say, ‘That sounds really frightening — tell me more about that,’” he said.
Consider your body language. The way you speak with the patient also makes a difference. You want to have a relaxed posture, with your arms at your sides, legs spread, and palms open. Being clearly interested and focused on the patient, not distracted by your phone or looking over the person’s shoulder, for example, can help you connect with and calm an agitated patient.
Give the person space, too. “No one likes to feel cramped or crowded,” said Zeller. With an agitated patient, you want to give him at least two arm’s lengths’ distance away so he doesn’t feel corralled. “Make sure the person can see an exit [from the room],” said Zeller. “If people can see that they have an escape route, they will automatically feel more comfortable.”
Consider the patient’s experience. “You want to see things from your patient’s view and preempt [a negative response],” said Wright. “If you know that it will take 15 minutes until the labs come back, tell the patient that. And if I haven’t had a break and am going to be eating at the nurse’s station while we wait for the labs, I will tell the patient that, so I head that problem off at the pass.”
If your patient is agitated, you can ask whether dimming the lights in the room or moving to a quieter area (if possible) would help. Ideally, you want to remove them from any source of aggravation, if you can.
Continually assess your patient. During your patient encounter, consider whether the situation is improving or worsening. Goodloe said, “If you try to de-escalate verbally from 10 feet away and they continue to escalate, you might consider calming medication in a hospital setting.” “If we don’t do this, they’ll run the risk of hurting themselves or a nurse or another doctor…ask, ‘What do we need to do to keep everybody safe?’”
Focus on What You Can Control
Assessing and addressing a patient’s emotional state are part of the patient encounter. And how you approach that encounter may determine whether they calm down — or spiral. “When you respond defensively, you’re priming these people for something to happen,” said Wright. Your response is always within your control.
“You can be apologetic — ‘I’m so sorry you had to wait for so long,’…that goes a long way.” You can use empathy, “I’m so sorry this happened to you.” You can convey that you’re frustrated with how the “system” works, too: “We’re really slammed right now and short-staffed. I’m so sorry we couldn’t get you back sooner.”
The ability to de-escalate is about more than keeping physicians and staff safe, while that is most important. Once you de-escalate and get on the same page with that patient, where you’re listening, understanding, and empathizing, it also allows you to provide better quality care.
Kelly K. James is a freelancer, content manager, and author of The Book That (Almost) Got Me Fired: How I (Barely) Survived a Year in Corporate America. She covers health/wellness, business/career, and psychology topics from her home in the Chicago suburbs.
