Must a physician return a call to an abusive patient's parent?

From the Guidelines

A physician is not obligated to return a call to an abusive patient's parent, as prioritizing staff safety and well-being is essential in healthcare delivery. When dealing with abusive or threatening behavior from a patient's parent, the physician has the right to establish boundaries for communication and may refuse further direct contact 1. This approach is supported by the principle of professionalism in pediatrics, which emphasizes the importance of maintaining a safe and respectful environment for both patients and healthcare providers.

Key considerations in handling such situations include:

• Documenting the threatening interaction in the medical record
• Exploring alternative communication methods to ensure the patient still receives necessary care, such as referring the family to another provider or communicating through a patient advocate or office manager
• Following healthcare facility policies addressing threatening behavior, which may include reporting threats to security personnel or law enforcement if warranted
• Ensuring that urgent medical needs of the patient are still addressed through appropriate channels, even while establishing boundaries with the abusive parent

It is essential to note that while physicians have ethical obligations to provide care, these obligations do not extend to situations where their personal safety is at risk 1. By prioritizing staff safety and well-being, physicians can maintain a professional and respectful environment, ultimately benefiting both patients and healthcare providers.

From the Research

Physician's Responsibility to Abusive Patients

• There is no direct evidence to suggest that a physician must return a call to an abusive patient's parent, but several studies highlight the importance of managing violent and aggressive behavior in healthcare settings 2, 3, 4.
• Healthcare providers should be knowledgeable about co-occurring conditions, stress related to hospitalization, and the use of resources such as Behavioral Emergency Response Teams (BERT) to prevent violent situations 2.
• Simple agitation may unpredictably progress to overt aggression and violence by any patient, and individuals with unusual agitation and aggression should be treated as an emergency to mitigate the progression to physical violence 3.
• Dealing with violence and aggression requires a medical approach to diagnose and treat, while trying to maintain safety and function, as well as a person-centred approach to understand and address psychological and emotional distress 4.

Managing Abusive Behavior

• Skilled communication, non-confrontation, relationship-building, and negotiation represent the best way to manage situations and avoid harm 4.
• Doctors should know about de-escalation and non-drug approaches, but also be confident about when physical restraint and drug treatment are necessary, and how to go about using appropriate drugs, doses, monitoring, and aftercare 4.
• Health leaders should be aware of the ethical implications of maintaining patient experience and care team well-being when faced with coercive behavior, such as bullying by patients and families 5.
• A comprehensive dyadic parent-child intervention is suggested for violence prevention in cases where adult patients with schizophrenia use violence towards their parents 6.