Make this page my home page
  1. Drag the home icon in this panel and drop it onto the "house icon" in the tool bar for the browser

  2. Select "Yes" from the popup window and you're done!

6 ways to defend yourself against verbal abuse

EMS1.com News

July 23, 2013


The Art of EMS
by Steve Whitehead

6 ways to defend yourself against verbal abuse

A verbal attack can be personal; here's how to deflect the blow

By Steve Whitehead

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 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
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 than our gender, our ethnicity, our belief about creation or our choices regarding physical intimacy? 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
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:

  1. Recognize that you are being 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 that the patient spoke, but it should still exist.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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?

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of 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 steve@theemtspot.com or at Steve.Whitehead@EMS1.com.
Comments
The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Michelle Pomarleau Michelle Pomarleau Saturday, July 19, 2014 3:59:37 PM Thank you so much for the sound advice! I was seriously considering leaving the field because of all the verbal abuse.....I wish companies would train their employees on how to handle patient abuse.
Michelle Pomarleau Michelle Pomarleau Saturday, July 19, 2014 4:04:59 PM "Handle abuse from patients"
Russell Blackburn Russell Blackburn Monday, September 08, 2014 11:12:23 AM I am a cna and I have just been verbally attacked i had false statements made against me about my work ethic. I immediately got support from my DON and ADON they spoke to the patient but I still have to provide care for him today. I don't feel like enough was done but, reading your article had made me feel a little bit better and had given me some ideas of what approach I will take with them for the rest of the day and future days. Thank you for writing this article. I don't feel so alone anymore

Today's Top Stories

Tuesday, October 21, 2014
  • CDC to revise Ebola PPE protocolEMS1 Article Comments1
  • 43 in Dallas declared 'Ebola free'

Line-Of-Duty Deaths

Submit information on fallen EMS providers in your area.

Featured Columnist

Michael Gerber

Creating a Quality EMS Future

From measuring industry progress, to community paramedicine and the decline of ALS, EMS leaders highlight...

    Featured Product Categories