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Disruptive patient behavior, particularly violence, is a growing problem that has been exacerbated by the COVID-19 pandemic.^1,2 Patient-physician conflict over COVID vaccines, treatments, and masking easily can become difficult to control.

Violence and agitation can be triggered by many different factors. These factors can be categorized in various ways. The list of triggers below is divided by responses to healthcare provider behavior and communication, environmental factors, and symptoms of patient illness. Understanding what causes disruptive behavior can help prevent and de-escalate it.¹

Many insureds call the Risk Management Department for advice about terminating treatment of a verbally abusive patient who does not pose a safety threat. They worry that dismissing the patient will prompt the patient to file an abandonment lawsuit or will elevate the patient’s anger. Although verbal abuse by a patient should not be tolerated and falls within The Joint Commission’s definition of “workplace violence,”¹ if it does not include physical threats or violent behavior, it generally will not provide grounds for terminating the treatment of the patient without notice.

In the following case, the patient and his wife were removed from the ED for using profanity and issuing threats. The patient may not have become disruptive if de-escalation strategies had been used. Consider what could have been done differently.

When a malpractice lawsuit is filed, lack of documentation can significantly complicate the process of proving the patient’s treatment met the standard of care and did not cause the patient’s injury. In the following case, the emergency department (ED) physician failed to adequately document three different aspects of the patient’s care: her disruptive behavior, her departure from the ED against medical advice (AMA), and her follow-up telephone conversation. Each failure complicated the defense of the ED physician’s case.