When faced with the challenge of treating a disrespectful patient, healthcare professionals — bound by a commitment to the well-being of their patients — can find themselves at a crossroads. Do they move forward despite the behavior or is it their right to refuse the patient?
Such an issue arose in 2020, when a Canadian hematologist worked with a non-verbal patient who was originally thought to have lymphoma, but was later diagnosed with a different rare condition. Throughout treatment, the hematologist stated the patient’s mother was “argumentative, intimidating, bullying, angry, sarcastic and demeaning.” Two years later, the same patient was referred to the hematologist, who declined to treat the patient due to the mother’s previous behavior.
A physician’s right to refuse treatment is not a black and white issue. But with violence toward healthcare professionals rising, there is reason for discussing when and how a healthcare worker can and should refuse treating a patient. With this in mind, we asked the Figure 1 community for their thoughts.
Here is what more than 1,500 HCPs had to say.
It’s All About Respect
In the medical world, it is not uncommon for patients to disagree with their healthcare provider. And HCPs generally do not take issue with this. In fact, one of our respondents stated, “I am fine if you disagree with me but do so respectfully. I believe in empowered patients and caregivers but not abusive.”
The issue seems to be when patients take a disagreement a step too far and become disrespectful. When we asked the Figure 1 community if they agree that HCPs should have the right to refuse a patient who is egregiously disrespectful, a whopping 88% said yes.
Some HCPs believe in very strict policies towards disrespectful or aggressive behavior. One nursing director shared, “I will give ONE stern warning for yelling, foul language, etc. After that you are leaving the office and will be discharged. Any direct threat, belittling, aggression toward staff is immediate discharge.”
HCPs Have the Right to Refuse, However …
Nearly all HCPs agree that when patient behavior is getting out of hand, they have the right to refuse the patient. However, many of our respondents gave a caveat. One respondent stated, “I think it is acceptable to refuse care based on behavior, unless the behavior is clinical in nature; such as psychological issues.” And another shared, “As long as the patient has an option to go elsewhere for healthcare, I think ‘sacking’ a patient who behaves rudely is fine.”
Looking at the case discussed earlier, we had respondents take either side of the situation. Where some respondents believed “in this case it wasn’t the patient that was the issue! It was the mother. Why is this patient denied care?” Others took the point of view that “the mother is acting on the patient’s behalf to communicate their issues. That is what the busy clinician is asked to deal with and the behavior is not acceptable and they are within their rights to refuse to engage with an unsafe/abusive work environment.”
It seems that many HCPs believe in refusing patients based on extreme behavior. But, the debate on how extreme the behavior needs to be, or the exact circumstances differ from person to person. One internal medicine resident seemed to encompass the beliefs of most of our respondents when they said, “It is your right to feel safe and comfortable in your workplace as much as it is the patient’s right to feel safe and also get the proper treatment. What I think is if an alternative competent doctor is there and can attend the patient then you can refuse. Otherwise if it is an emergency situation and I am the only one available then I don’t have any other option.”
Published November 20, 2023
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