For years now, I have taught EMS responders to keep in mind that nothing a patient says is personal. While teaching classes on successful verbal interactions with patients, I have frequently emphasized that the patient doesn’t know you. Therefore, nothing that they say can be taken personally. How could it be personal if they don’t know you personally?
I’ve changed my mind. Sometimes, the verbal abuse hurled at us can be personal. And not taking it personally can be remarkably difficult. Verbal abuse is a hostile act and it is intended to cause harm.
Since a verbal attack leaves no physical mark, we often ignore its intent, and we also disregard its potential to harm us. But, I’ve come to believe that these episodes can do harm, if we fail to properly defend ourselves emotionally. To do that, we first have to recognize that a verbal attack on our person is not benign, even though we’ve been taught otherwise.
Verbal attacks – sticks and stones – do hurt
As children, we learned that "sticks and stones can break our bones but words could never hurt us." I believed it. You probably believed it too. The childhood nursery rhyme is wrong. Words can hurt us. Some words can hurt for a long time. Some words can be carried with us for a lifetime and nobody will ever see the scars.
Our awareness that verbal abuse can be harmful begins with the recognition that some of our patients are remarkably good at verbal abuse. Many of them have been victims of abuse themselves and they learned the language of abuse at a very young age. Some verbal attackers can size us up remarkably fast and pick out our weaknesses and insecurities with great accuracy.
Physical and social targets of verbal attack
The target of the verbal abuser's attack may be physical or social. Any physical imperfection you have may become a target for a verbal attack including your weight, height, the size of your nose, your receding hairline or your visible birthmark. If the verbal abuser suspects that you harbor any insecurity over your appearance, he or she will likely take a shot.
If a physical feature can’t easily be exploited, then social attributes may also be tested. Gender, race, religious beliefs and sexual orientation tend to be effective areas of emotional vulnerability. What could be more personal? These things define us as a person. They are deeply personal and that’s why they are so frequently the subject of verbal attacks.
Mounting a defense against verbal abuse
This recognition that verbal abuse can be extremely personal has left me considering an important question. What should we do to defend ourselves against verbal abuse from our patients?
Here are some of the ideas with which I’ve been experimenting:
- Recognize that you are being verbally attacked:While a verbal assault may not be as obvious as a punch or a kick, but it is still an attack. The person targeting you with verbal abuse is attempting to hurt you. They want you to feel pain and discomfort. They want to feel that they have control, power and influence over you. They want you to feel hurt, sad or angry and they are probably quite good at instigating these feelings.While you may have been trained to ignore these behaviors, recognizing and defending yourself against a verbal assault is appropriate. Your internal defense against a verbal attack may be as invisible as the words that the patient spoke, but it should still exist.
- Check your physical safety.Physical assaults are often preceded by a verbal attack. Use the patient’s verbal aggressiveness as a prompt to reconsider your safety. Is the patient properly restrained? Do you have the resources available to manage the patient’s potential for escalation? Do you know the location of your exits? Do you have a reliable way to call for help? Verbal abuse should immediately prompt you to double check your physical safety. If you aren’t safe, back off until the resources you require are present.
- Relax your posture.It’s easier to remain calm if you have an open body posture and relaxed muscles. Take a deep breath. Open your hands. Calm your facial expression and think about your words before you speak. Just because the patient is speaking with a rapid cadence doesn’t mean that you need to have a quick response.As long as you are not in physical danger, there is no need to move or speak quickly. You can move the scene forward at your own pace. Have confidence in your own authority. Do your best to keep yourself relaxed, calm and alert.
- Say to yourself, “How interesting.”The phrase, “How interesting,” places us in a powerful position of analysis. When we make a conscious choice to analyze a situation we change our mindset. The process of analysis reminds us that we always have the ability to choose how we will feel in response to something someone says.Consider why the patient feels that causing others emotional pain is their best course of action. How has this worked for them in the past? This is a behavior that few people witness on a regular basis. The fact that it is rare makes it interesting on at least a cursory level. Choosing fascination over anger can help you see the big picture.
- Make an honest observation.We’ve been trained to ignore the hurtful things that patients sometimes say, but I’ve been exploring a more reserved confrontational option. Instead of dismissing the remark, try calling the patient’s bluff and identifying the nature of their aggressive statements.Try a response like, “That’s a very hurtful thing for you to say.” or “Those remarks are highly inappropriate.” or “I’m not going to engage in a conversation that’s profane or hateful.” Calling the patient out on their own inappropriateness might be more effective than simply pretending that they aren’t being verbally abusive.
- Consciously forgive the offense.Forgiveness is a powerful tool. I don’t believe that people are born with hatred inside of them. Hatred is learned and it is something that passes from person to person. The patient’s ability to verbally attack you is something that they learned consciously or not.After the call is over, take a moment and purposefully allow yourself to forgive the patient for every attempt that they made to cause you emotional pain. When you choose to forgive the patient for the words that they spoke, you automatically place yourself in a position of power. You recognize that the words that were spoken did have the power to hurt you and you also have the power to heal, let go and move on.
If you work in EMS, it is almost inevitable that you will be the subject of verbal abuse. What do you do to cope with the hurtful things that patients’ can sometimes say? Do you have any good tips for managing the verbally aggressive patient?
Read next:This 1 magic phrase will stop patient conflicts
This article, originally published on July 22, 2013, has been updated
About the author
Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of the blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at email@example.com.
- EMS Education
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- Violent Patient Management