How to respond to incivility

When you encounter rudeness, discrimination, or violence in your practice, how should you respond? Here are seven strategies:

1. Try not to take it personally. This step might be the most difficult. But remember that the other person’s behavior likely stems from stress, fear, fatigue, illness, ignorance, or trauma. It’s not about you, although it is being directed at you. Try to stay calm.

2. Take a timeout. When someone’s behavior is inappropriate, you don’t have to stay in their presence and endure it. If it’s not an emergency situation, tell the person you need to take a moment to process what just happened, and leave the room for a few minutes. This break may give the other person time to calm down and act in a civil manner.

3. Check your feelings. De-escalating a situation will be extremely difficult if you're feeling exhausted, hurt, or defensive. Take note of your feelings and take a deep breath before you respond.

4. Choose your response. Sometimes the best response is to keep the interaction brief and move on. Other times, you may need to address the behavior directly and confidently, but respectfully. For example, “It sounds like you’re mocking my accent. I am proud of my accent because it reflects the fact that I speak more than one language — a gift that allows me to connect with people of many backgrounds, enriching my life.”

5. Know when to call in help. If an interaction moves from uncivil to violent, your best attempts to defuse the situation will probably not be effective. Discern when it is time to get help, perhaps from security or a colleague who can step in and interrupt the bad behavior. Likewise, be aware of when others may need you to step in on their behalf.

6. Make sure your organization is doing its part. Your organization should have policies in place to protect physicians, staff, and patients from any form of harassment, such as a policy that it will not honor patients' requests for a new physician based on prejudice. Organizations must also create a culture in which physicians and staff feel comfortable, not judged or ignored, when reporting instances of bigotry, rudeness, harassment, or any scenario that causes anxiety or fear. Individuals must trust that their concerns will be taken seriously without negative repercussions.

7. Set boundaries. Learn to recognize people who are unsafe or inappropriately needy and establish safe and healthy boundaries. At times, you may need to reassign a patient to a different physician or even discharge a patient.

Read the full FPM article: “Incivility in Health Care: Strategies for De-escalating Troubling Encounters.”