Interacting with angry patients and defusing tense situations has become an almost daily occurrence in medical offices and facilities across the U.S. While no single response or technique will work in every situation, verbal de-escalation can help.
De-escalation involves “transferring your sense of calm and genuine interest in what the patient wants to tell you by using respectful, clear, limit setting.” (1) Using the following de-escalating phrases can help patients feel heard and allow them to move from cross to calm.
(Please note . . . these phrases will not apply in every context. When responding to escalating behavior, consider the individual patient, the circumstances, and the overall situation. If at any time the patient threatens harm or you feel unsafe, contact the police or call 911 immediately.)
Listening and acknowledging
These phrases let the patient know you are paying attention and are focused on what they have to say.
- I want to understand what you’re feeling/thinking. It’s important to me.
- I’m going to listen to every word so we can figure out what to do about this.
- Tell me why you think that.
- I would like to learn why that is.
- Please help me understand what you need.
- Tell me if I have this right.
- Can you tell me more about that?
- I can see how much this has affected you.
These phrases offer patients a way — other than “acting out” — to get what they want.
- You’re yelling/raising your voice. Please use a calm tone and explain what’s going on.
- I can tell you’re very stressed. Please use a calm tone and tell me what’s happened.
- We all have to be respectful, even if we disagree.
- Let’s treat each other well, even if we disagree.
- We can be angry and still be respectful.
- We’re about respect here, even when we disagree.
- You have to be respectful because we’re not here by ourselves. There are other patients and other staff members. We have to think about everyone.
- Name-calling is not allowed. If you’re angry, that’s okay. But you can’t call people names when you’re angry. You can say I’m angry and tell me why. I’ll listen.
These phrases can be used to let the patient know you want to help solve the problem.
- What more do you need to hear to understand this?
- What questions do you have?
- What has helped you in the past?
- Did that work? What could we do that works?
- That’s a smart question.
- What’s the right thing to do here?
- What are you trying to make happen here?
- Whatever you want to ask to understand this, please ask.
- I would like to know what you expected when you came here. Even if I can’t provide it, I would like to know so we can work on it.
- This one’s not a choice. [Practice policies, federal law] say(s) we have to do it this way.
- Some things you decide. Some things I decide. Some things we decide.
- They [or other people/doctors] are in charge of their choices. You’re in charge of your choices.
- I experienced something similar in the past. Would it be helpful to hear some advice on how I dealt with it? I’m also happy to just listen.
Resources from TMLT
CME course: Dealing with challenging patient encounters
1. Pope K. Crisis intervention in dealing with violent patients: De-escalation techniques. Available at paetc.org/wp-content/uploads/2014/10/De-escalation-PACE.pdf. Accessed August 30, 2023.