Dealing with Angry or Distressed Patients

SJT Textbook: Dealing with Angry or Distressed Patients

Angry Patients MSRA SJT

This guide covers the high-stakes topic of Angry Patients MSRA SJT scenarios. In the Professional Dilemmas paper, examiners test your ability to maintain safety and professionalism when faced with aggression, prioritizing de-escalation over confrontation.

🎥 Video Lesson (YouTube)

🎧 Podcast Lesson (Spotify / Apple / Amazon)

🎯 THE CORE PRINCIPLE

Dealing with angry or distressed patients is about combining safety, empathy, and structure. Anger often reflects fear, pain, delay, or miscommunication rather than hostility towards you personally. Your role is to de-escalate, not to win an argument. That means noticing early signs of escalation, protecting yourself and others, acknowledging emotion, and seeing if there is a solvable problem underneath.

In the SJT, high-scoring options show you scanning for risk, choosing a safe environment, using a calm tone and body language, and validating how the person feels. You then map what has happened from their perspective, explain what you can and cannot do, set clear behavioural limits, and offer realistic choices. If risk persists or increases, you escalate early (senior, security, police) and follow incident reporting processes, including staff support and debrief.

The exam penalises matching the person’s anger, making promises you cannot keep, ignoring safety, or walking away without ensuring that risk is contained and the situation is handed over appropriately.

⚡ HIGH-YIELD ACTIONS (What Scores Points)

1. Quickly assess the environment and maintain a safe distance and exit route.
2. Use a calm stance and tone, keeping your body language non-confrontational.
3. Acknowledge and name the person’s feelings in simple, non-judgemental language.
4. Allow brief venting while you listen, then clarify what has happened and what matters to them.
5. Separate the person from the behaviour and set clear, respectful behavioural limits.
6. Offer specific, realistic choices (for example: speak calmly here, move to another room, timed review).
7. Bring in colleagues, chaperones, seniors, or security when risk increases.
8. Summarise what has been agreed, including any follow-up or complaints routes.
9. Make a factual, contemporaneous note of behaviour, risks, actions, and outcomes.
10. Complete incident reporting as per local policy and ensure staff support and debrief.

In Angry Patients MSRA SJT questions, you must understand the “Escalation Cycle.” Your goal is to intervene early at the trigger phase, rather than waiting for the crisis phase.

Overall, trap answers prioritise your own irritation or convenience, use threats or appeasement, and fail to protect safety or follow organisational standards.

💬 MODEL PHRASES (Use These in SJT Logic)

* “I will keep my voice calm; I need you to keep your voice down and your hands by your sides so we can continue safely.”
* “Let me summarise what has happened from your point of view and then I will explain what we can do next.”
* “Here are two options I can offer today. Which of these would you prefer?”
* “I am going to bring a colleague in so that we can sort this out safely together.”

Calm stance • Acknowledge feeling • Listen and let them vent • Map the issue • Explain limits • Resolve with choices

📋 QUICK FAQ

When should I end the consultation?
End it if the situation remains unsafe despite clear limits and attempts at de-escalation. Explain that you are stopping to keep everyone safe, signpost alternatives or follow-up where appropriate, and involve senior staff, security, or police as per policy.

Should I report verbal abuse as well as physical incidents?
Yes. Follow your organisation’s incident reporting system and the NHS Violence Prevention and Reduction Standard. Verbal abuse still affects staff wellbeing and should be logged and addressed.

What if clinical news triggered the anger or distress?
Acknowledge the emotion first, then revisit the information in clear, non-technical language. Offer to involve a senior colleague, provide written information, and arrange a follow-up if needed.

How do I set limits without making things worse?
Use calm ‘I’ statements: describe the behaviour, state the standard, and offer choices. For example: “I want to help, but I cannot do that while you are shouting. If we can speak calmly, we can look at what happens next.”

What must I write in the notes?
Record the behaviour (not labels), what was said and done, any risks identified, who was present, options offered, decisions made, escalation steps, and any incident report completed.

📚 GMC ANCHOR POINTS

• Communicate clearly, listen, and treat patients and relatives with dignity and respect, even when they are distressed or angry (GMC Good Medical Practice 2024).
• Take prompt action if you think patient safety, dignity, or comfort is being compromised (GMC Raising and acting on concerns).
• Support and protect colleagues from bullying, harassment, and violence (GMC Leadership and management for all doctors).
• Keep clear, accurate, and contemporaneous records of significant events, including aggressive incidents and how they were managed.

💡 MINI PRACTICE SCENARIO

A patient in your clinic becomes increasingly angry about delays. They stand up, move closer, and raise their voice, saying, “This is a disgrace, someone is going to get hurt if you do not sort this now.”

Best action: Position yourself with space and a clear exit, invite a colleague or chaperone to join you, acknowledge their frustration, set calm behavioural limits, and offer safe, realistic options (for example: continuing calmly now, moving to a quieter area with a colleague, or arranging a timed review).
Why: This approach prioritises safety, uses de-escalation skills, sets boundaries, and offers choices, all in line with GMC professionalism and national violence prevention standards.

🎯 KEY TAKEAWAYS

✓ Safety first: scan the room, keep an exit, and call for help early.
✓ Validate emotion: angry people often feel frightened, ignored, or powerless.
✓ Set clear, calm limits on behaviour and separate the person from the behaviour.
✓ Offer practical choices rather than threats or impossible promises.
✓ Document what happened, complete incident reports, and support staff with debrief.

🔗 RELATED TOPICS

* → Active Listening
* → De-escalation Techniques
* → Breaking Bad News
* → Working with Relatives and Carers
* → Raising and Acting on Concerns

📖 FULL PRACTICE QUESTIONS

Example SJT — Best of 3 (8 options; choose three)

In the emergency department, a relative is shouting about long waiting times and swearing at reception staff. Other patients are watching and looking uncomfortable. You are a junior doctor nearby.

Options:
A. Shout back so they can hear you over the noise and tell them to sit down.
B. Ignore the situation and continue your work; it is not your problem.
C. Ask the relative to step with you to a safer, more private area where staff are nearby.
D. Acknowledge that they are frustrated and apologise for the distress the delay has caused.
E. Calmly explain what you can and cannot do, outline realistic timeframes, and offer practical options such as an update review.
F. Promise they will be seen next, regardless of triage order, to stop the shouting.
G. Ask a colleague to join you or call for senior/security support if you have concerns about safety.
H. Tell the staff to tolerate the shouting because “they are just stressed.”

Example SJT — Rank 5 (best → worst)

In a busy clinic, a patient becomes increasingly agitated about a perceived delay. They stand up, step towards you, and raise their voice. The waiting area is crowded.

Options:
A. Position yourself with space and an exit, invite a colleague in, acknowledge their feelings, set clear behavioural limits, offer safe choices (continue calmly here, move to a private room with a chaperone, or arrange a timed review), then document and incident-report.
B. Raise your voice and warn that if they do not sit down immediately, you will discharge them from the clinic.
C. Ignore the behaviour and carry on typing until they calm down.
D. End the consultation and walk away without any explanation or arrangement for follow-up or safety.
E. Promise that they will be seen “next, guaranteed” to stop the shouting, even though other patients are more unwell and have been waiting longer.