angry and violent customer

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violence against doctors, tackling angry patient

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Tackling violence against doctors… -Panel discussion :

Tackling violence against doctors… -Panel discussion Dr.S.Easwaramoorthy Panelists: Dr.S.Karuppanan Dr. Ganapathy Dr.Sounderrajan Dr.Nancy Thanu Dr.Ranganathan Dr.Jayanth Kumar EIMA

Clear Present Danger…:

Clear Present Danger…

The Victim…:

The Victim… Next time, it could very well be one of us!

Don’t care attitude…:

Don’t care attitude…

Reactive?:

Reactive?

Our Customers…:

Our Customers… Past , Present & Future Why? Unrealistic expectation of our customers Poor Doctor patient relationship We are not Demi God anymore! Loss of trust & respect Aggressive mind set of society Violence on road, school, public place

Violence against Doctors :

Violence against Doctors Unique in our country It is a Global Issue Myth Truth

It is a Global Issue!:

It is a Global Issue! USA UK China ….

We are no longer Demi Gods…:

We are no longer Demi Gods…

Empathy:

Empathy

Whom you want to be…:

Whom you want to be… Cure where possible Care always Communicate maximum

Angry & Unhappy customers… Scene 1:

Angry & Unhappy customers… Scene 1 This 45 yr male had undergone IM nailing for fracture left femur 5 days ago. Now he is ready to go home but the relatives were unhappy with the bill amount and asking for explanation and concession. They quarrel with the hospital front office staffs and they want to talk to you!

Healer Vs Stealer!:

Healer Vs Stealer!

Anger due to excess bill amount…:

Anger due to excess bill amount… Reestablish rapport with patient & relatives Bring them to ‘ Yes’ momentum Narrate the reasons for the excess bill amt Let them know you are also keen for a solution Take them to ‘the designated person’ for amicable solution

Art of managing angry patients… Do’s:

Art of managing angry patients… Do’s A ctive listening A llow them to vent out A ccept their anger A cknowledge your limitations in treatment A pologize , if needed?!

Active Listening…:

Active Listening…

Art of managing angry patients… Don’ts :

Art of managing angry patients… Don’ts Arguing with a crowd Identify & isolate key persons to a counseling room & talk Don’t mirror their anger Be curious but don’t become furious!

Angry & violent customers… Scene 2:

Angry & violent customers… Scene 2 50 year farmer, admitted in a critical condition following poisonous snake bite. Counseling the relatives at the time of admission… Patient remains unwell and develops respiratory distress and needs ventilatory support and dialysis. How to convince and console the agitated relatives?

Nobody likes us!:

Nobody likes us!

Angry & Unhappy customers… Scene 3:

Angry & Unhappy customers… Scene 3 18year BE student RTA/ brought in by his college friends in an Unconscious state GCS: 6 Large Subdural hematoma Operated and now in ICU on ventilation Dismal prognosis

Violence against Doctors :

Violence against Doctors Common in communally or politically sensitive Zone Eg : Slum/Industrial areas Also in well developed regions/ well educated people Myth Truth

Unexpected Deaths…:

Unexpected Deaths… Death in the emergency ward after failed ACLS in a patient with acute MI Sick child in Dengue shock syndrome dying at the PICU in spite of aggressive resuscitation Death on the table in OT after emergency hysterectomy for PPH Death of patient in OT/ward after elective cholecystectomy

Can you anticipate and avoid such conflict…:

Can you anticipate and avoid such conflict…

Cause of Violence on doctors:

Cause of Violence on doctors Both public & media have poor image of our profession Lack of faith in legal system & Police Violence is a means to redress grievance Mobo-cracy /Small time leaders Caste based & other political issues

When, To Whom & Why?:

When, To Whom & Why? Night/Early morning Junior doctors are more vulnerable Reasons: Delay in treatment Unsatisfactory treatment Inadequate information Unexpected complications Unacceptable expense

Genesis of Violence:

Genesis of Violence

Assault Cycle:

Assault Cycle Deescalation tactics

We are soft targets!:

We are soft targets! Mob make fun of us…

Past, Present & Future!:

Past, Present & Future!

In a lighter note…:

In a lighter note…

Characteristics of Mob Violence:

Characteristics of Mob Violence Close relatives are often not in the scene Often led by ‘local goons or politicians’ Make bizarre allegations Least interested to listen to your explanations Predatory violence Emotionally detached, goal directed, well planned Can explode into a scene of uncontrollable violence at anytime

Aftermath of Violence:

Aftermath of Violence Seek help of your colleagues Unity is strength Ask for MLC/request for Post mortem Take photographs of damage Police/court Insurance Send the injured staffs to nearby hospital for evaluation and obtain Injury certificate Insist the police for booking the culprits under Hospital Protection Act

Slide 38:

Zero Tolerance Policy

Deterrent to violent Incidents:

Deterrent to violent Incidents Display regarding ‘CCTV surveillance’ Display ‘Hospital Protection Act’ poster Display of fee structure Security/Police Panic alarm/Siren Code ‘White’ Metal detectors! Card controlled access Good lighting Avoid being alone! Ensure large number of your fellow doctors during any crisis Give positive news in the media Persuade media persons not to write one sided stories

Money Matters…:

Money Matters… Display fee structures clearly Avoid unnecessary scans & tests Say’ No’ to kickbacks No charge for managing complications Show humanity in financial dealing after death

Odd suggestions… Defensive Vs Offensive strategy :

Odd suggestions… Defensive Vs Offensive strategy

Learn the art of Self Defense!:

Learn the art of Self Defense!

ABCD of Crisis Management:

ABCD of Crisis Management A nticipate trouble & Act swiftly B e Present C ommunication Clear the crowd Deescalate the situation Empathy D ocumentation E ngage the seniors Seek second opinion F ly away to safety!

Slide 45:

Thank you…

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