Managing threatening and violent patient behaviour

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COVID-19 has made the work environment increasingly challenging for physicians, healthcare workers and support staff. We recognize the pandemic has increased conflicts in care spaces over requests for vaccine and mask exemptions, as well as patients seeking prescriptions for ivermectin and other unproven medications and therapies.

CPSA is saddened to learn of an increase in violent threats against physicians and support staff, as well as personal attacks, threats—including death threats—and abusive language directed at physicians on social media.

This behaviour is simply not acceptable and CPSA has no expectations that physicians will tolerate abusive or harassing conduct by patients or the public, whether in person or online.

Abusive behaviour in care spaces

Physicians maintain the right to discharge a patient if the patient is physically or verbally abusive, threatening or violent towards the physician, their staff members or other patients. The use of discriminatory language, including racial slurs, towards a physician or staff members is considered abusive and threatening.

CPSA’s standard of practice on Terminating the Physician-Patient Relationship in Office-Based Settings clarifies CPSA’s expectations. If the situation escalates and there is a perceived or real threat of violence, physicians should not hesitate to contact local law enforcement or facility security for additional support. The top priority is your safety, the safety of staff members and the safety of other patients.

It’s important to document the patient’s behaviour and what they say in the patient’s record, particularly if you discharge the patient. This ensures that, should there be a concern raised about your decision, you have documented clearly what led you to make that decision.

Physicians cannot deny or refuse care to a patient based on the patient’s vaccination status or refusal to wear a mask or face covering, but can end the care interaction if the situation becomes verbally or physically abusive, threatening or violent. It is reasonable for physicians to expect their patients and other members of the public to treat them and their healthcare colleagues with respect. Abusive patients can be asked to leave the premises and may be subject to termination of their relationship with the physician and/or prosecution by law enforcement.

This advice applies to physicians in urban and rural practice settings. It is not okay for any physician to feel unsafe in their practice—this includes physicians in rural communities where there are fewer options for patients to access care. Please don’t hesitate to reach out to CPSA for additional support and guidance.

Abusive behaviour online

If you’re experiencing abuse or harassment online:

• Keep a log with all details surrounding the abuse or harassment, including the date, time and screenshots of the behaviour.
• Do not engage with the individual. The individual is likely looking for a reaction and engaging could fuel them further.
• Mute the individual. Most social media and online platforms give you the option to mute individuals. When you do this, you will no longer see their content but they will still be able to see your content, visit your profile and possibly send you direct messages.
• Block the individual. This will make it so the user can no longer contact you through the platform on which you blocked them.
• Report the individual. Depending on the situation and the platform, reporting an individual can result in someone’s post being removed, or their account possibly being suspended or deleted from the platform.

Other considerations:

• Sometimes people will create new or multiple accounts to harass someone. If this happens to you, continue to block and report the accounts that are abusing or harassing you.
• If someone is threatening you or others in your life, you should contact local law enforcement to seek further advice and guidance.

CPSA Council’s message to Albertans

CPSA Council recently published a letter to Albertans advising that very few vaccine exemptions are expected to be given for medical reasons. The letter urges Albertans to be respectful to healthcare providers and support staff, and advises that abusive, threatening or harassing behaviour is unacceptable—advising a physician’s right to formally discharge a patient from their care if that patient or their family is making a healthcare professional, or any staff member, feel unsafe.

The letter also indicates it is not appropriate for a patient to report a physician to CPSA if the physician’s professional opinion is that the patient does not qualify for a vaccine or mask exemption for medical reasons. CPSA can and will dismiss such vexatious complaints.

Need help, guidance or support?

CPSA is here to answer questions and support you in your practice. Please contact us at covid19@cpsa.ab.ca.

Helpful resources for your practice

• WATCH: Physician workplace safety | A conversation with Red Deer RCMP, a forensic psychologist and an Alberta physician about violence in the workplace
• Terminating the Physician-Patient Relationship in Office-Based Settings standard of practice
• CMPA – Physician-Team | Dealing with Conflict | CMPA Good practices (cmpa-acpm.ca)
• PROactive: Identifying and Managing Violence in the Workplace | 2.5-hour self-paced online modules through U of C CME
• Guidance for physicians: requests for COVID-19 vaccination exemptions
• Patient FAQ: Exemption Requests for Vaccination
• Guidance for community medical clinics: COVID-19 info for fall 2021
• A letter to Albertans from CPSA Council
• CPSA 2020 annual report | Safety first: supporting a physician’s right to safety in the workplace

Resources to manage abuse or harassment online

• Facebook: What should I do if I’m being bullied, harassed or attached by someone on Facebook
• Facebook abuse resources
• How Twitter handles abusive behaviour
• Reporting harassment or bullying on Instagram
• Report harassment or a safety concern on LinkedIn