'It happens frequently': What you need to know about the abuse of pharmacists by patients

Have you or a colleague been mistreated by a patient in the past year?Jamie Kellar, associate dean, academic at the University of Toronto’s Leslie Dan Faculty of Pharmacy, asked that question through an online audience poll during her presentation at the Ontario Pharmacists Association’s RxTalks conference. Almost everyone—95% of the audience—answered in the affirmative. “So it happens frequently,” Kellar said after the poll results came in. “I always find this astonishing to think about—that we're providing care and service yet in doing that, in some cases, we're being treated in ways that aren't respectful by those that we are serving.”When asked about the nature of the mistreatment they either experienced or witnessed, audience members cited verbal abuse, berating staff, yelling, demanding and disrespectful behaviour or blaming staff for problems with insurance coverage. They also described feeling—at the time of the incident—helpless, undervalued, stressed, embarrassed and miserable.These experiences go beyond the RxTalks audience. In a survey last year by the Canadian Pharmacists Association, almost four in 10 pharmacists said they experience abuse or harassment from patients at least weekly. Two out of 10 reported daily occurrences.In addition to the impact on the wellbeing of pharmacists and pharmacy teams, abusive patient behaviour can have a negative impact on the pharmacy, health system and the profession.“We know the data actually connects (patients’ mistreatment of pharmacists) to a number of things such as absenteeism—the more mistreatment people experienced, the more they call in sick, or they come to work but they’re not fully present,” she said. “We see decreased job performance leading to occupational stress and potentially burnout.”One of the most consequential effects is higher incidences of medication errors.“The big one in our field that consistently comes up is medication errors,” said Kellar. “We make more mistakes when we’re stressed or when we’re working in environments where we run the risk of being treated poorly.”Read: Mistreatment of pharmacists: Solutions to be highlighted at upcoming OPA conferenceAddressing the problem at the individual, team and organizational level is critical, she said.At the individual level, it’s useful to have a strategy for de-escalating a difficult patient-pharmacist situation. One way to do this is by applying a framework called GRIT—an acronym for a process that involves gathering your thoughts, restating an offending comment or asking the patient to repeat what they just said, inquiring to get more clarity and talking it out.In practice, this would translate into pausing—instead of reacting immediately—after a patient has acted inappropriately and using that moment to decide whether to deal with the problem on the spot or wait, perhaps choosing to call the patient later.“There are some instances where in this moment, it might not be the right time to address it—you might not be able to respond instead of react, you might be so hurt and so angry or confused that you're not in a position to be able to have a dialogue that would be constructive or helpful,” said KellarWhen you do decide when and where to handle the situation, the next step is to restate what the patient said or asking the patient to restate the offending comment. What this does, said Kellar, is give patients an opportunity to either clarify or correct what they said. In many cases, patients feel embarrassed when they realize what they’ve done and they’ll often apologize.The inquiring and talking-out parts of the GRIT framework are all about digging deeper to find out the patient’s intentions and concerns, and to get into a conversation about how you might be able to help them. This conversation could also include a discussion with the patient about acceptable behaviours in pharmacy.Read: Conestoga College to open Centre for Pharmaceutical StudiesStrategies at the team, pharmacy and organizational level are also important, said Kellar. Creating zero-tolerance policies around abusive patient behaviour is a good starting point. These policies should be clear and clearly displayed throughout the pharmacy.“CpHA has some nice posters on this to set the tone for what’s actually going to be tolerated within our pharmacy settings,” said Kellar.As part of the process of defining policies to address abusive or aggressive patient behaviours, pharmacies should also look at creating structures and procedures to support these policies. For example, is there an employee assistance program that a pharmacist can turn to after a particularly traumatizing interaction with a patient? Are there training programs to help the pharmacy team develop skills for de-escalating difficult situations?“All of these things are really important at an organizational level to not only have but also to disseminate,” said Kellar.As an example of an organization with a robust approach for dealing with abusive or violent behaviour in the workplace, Kellar pointed to the Cleveland Clinic. The Cleveland, Oh.,-based private-pay health system—which has clinics around the world—has a workplace violence committee, an online mechanism for reporting incidents, signage on units stating that violence will not be tolerated, “behavioural contracts” and training on inclusion and as well as in non-abusive psychological and physical intervention for caregivers.There’s also a “speak up award” to validate and commend those who do speak up against abusive behaviours.There are “very few” organizations today that have formal policies in place to address abusive patients, said Kellar. “It’s relatively new, but it's something that we need to move towards.”Read: Time to pull the safety lever: Burnout in pharmacy is not a self-care issue but a workplace problem

'It happens frequently': What you need to know about the abuse of pharmacists by patients

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