How do you react to an aggressive patient?

RE: How do you react to an aggressive patient?

Miriam Lodewyks — Thu, 14 Mar 2024 08:06:39 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243953#243953"]Funny how it's all so culturally dependent. Here, if a human causes transient pain to a dog that was evidently trying to bite, they risk their career. Whereas in other cultures, the same dog would make a nice hors d'oeuvres.[/quote]

Wow! Very true!

RE: How do you react to an aggressive patient?

Clive Ansell — Sat, 09 Mar 2024 09:46:05 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243981#243981"]

It can be used for the purposes of protecting property and preventing crime but even the police need a data release form for CCTV for crime investigations.

It has become far more restricted and I think that's a good thing. No longer can places put up a sign saying "smile, you're on cctv" but need a detailed breakdown of how your data is used, stored, kept and consented to, and who the data controller is. Barely worth the bother really.

[/quote]

It is very limited now.

A farmer friend that installed a CCTV security system on his farm and in his buildings, after having several episodes of theft of machinery, has been forced by the local authority to remove or relocate some of the cameras from his yard because a public footpath runs through the middle of it.

Even as far back as 2009, my car was vandalized while working away from home in Kent. Despite a brand new 360 degree all bells and whistles CCTV camera in the car park, and despite police being able to identify the vandals, they apparaently could not use the information as evidence because they were minors. Great. £600 lighter.

RE: How do you react to an aggressive patient?

David Mills — Sat, 09 Mar 2024 00:06:03 GMT

And as to this getting to DC level - just ridiculous.

As others have said there are layers here. Layers upon layers. The top layer is the health and safety of staff and if an animal injures someone something somewhere has gone wrong.

I suspect there is another side to this which is somewhat less palatable and nothing to do with the incident or the poor individual vet involved - seems like a decent vet to me really and he has my sympathy. Whichever key jangler robbed him in less so.

RE: How do you react to an aggressive patient?

David Mills — Fri, 08 Mar 2024 23:42:50 GMT

CCTV has been pretty hamstrung by GDPR. If it's recorded for any length of time whatsoever, you need consent and all sorts of things in place. Real time no but then what's the point in that?

Before GDPR it couldn't be used to monitor performance or actions anyway without express active consent.

It can be used for the purposes of protecting property and preventing crime but even the police need a data release form for CCTV for crime investigations.

RE: How do you react to an aggressive patient?

Clive Ansell — Fri, 08 Mar 2024 09:01:12 GMT

[quote userid="3585" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243967#243967"]But not because I think his actions are defensible, they are not. The defendant himself admitted to his HR department that he had “lost it”, and as a professional, “losing it” and taking it out on a patient is unacceptable.[/quote]

We don't have all of the facts of course, but there could be situations where his actions could be defensible, in a legal sense.

It could be that someone could be unwell or unduly stressed, and they reach a breaking point. If so, that person would need some help, not punishment.

He was a clinical director of a corporate owned practice, so it would be a resaonable assumption he could be under pressure from his corporate overlords to reach targets and improve productivity etc. Added to which, he was understaffed going from 5 vets down to 2.

RE: How do you react to an aggressive patient?

Glen McIntosh — Fri, 08 Mar 2024 08:01:34 GMT

I think a DC hearing was definitely overkill in this situation.

But not because I think his actions are defensible, they are not. The defendant himself admitted to his HR department that he had “lost it”, and as a professional, “losing it” and taking it out on a patient is unacceptable.

The point is that when confronted by HR, he admitted his wrong doing and was remorseful. That should have been the end of it.

Had he tried to defend and excuse his actions and had he not recognised the unacceptability of his actions during the in house disciplinary, then yes, reporting him to the RCVS would have been the appropriate action.

That wasn’t the case here, yet he still ended up before the RCVS.

He may not have been reported by corporate management, we don’t know. He could have been reported by any of his colleagues. Either way, his reporting to the RCVS strikes me as being somewhat malicious, prompted by any number of not so honorable ulterior motives, and it’s a pity the RCVS didn’t recognise that.

RE: How do you react to an aggressive patient?

Michael Woodhouse — Thu, 07 Mar 2024 22:26:24 GMT

[quote userid="4181" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243955#243955"]The admission that “Whilst in the corner of the room, the Respondent hit Bella repeatedly, first with his hand, and then, with a muzzle that had been handed to him” concerns me, and I would presume the public too, and seems beyond reasonable défense against being bitten [/quote]

If that was my own dog and I needed to do something to her, and she was reacting by snapping/biting then I think that's pretty much how it would go down. My old dog tried to bite me once and never again. I do think a tap on the nose or a firm tug on the lead are appropriate for a dog that is trying to bite/resisting muzzling. I could imagine a situation where it was the only proportionate response to the situation.

[quote userid="9239" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243954#243954"]Well, I hope I react before and not after I'm bit.[/quote]

Exactly. The situation is EXACTLY the same if the dog attempts to bite, whether it is successful or not.

[quote userid="5012" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243956#243956"] I worked in a practice about 2 years ago that had a CCTV camera in the operating theatre, that had only one door and no windows. [/quote]

Dangerous drugs kept in there?

RE: How do you react to an aggressive patient?

Beats — Thu, 07 Mar 2024 20:35:45 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243956#243956"]I have been known to disconnect CCTV cameras before, I believe we have a right not to be filmed if we so wish?[/quote]

What you do have, to my knowledge, is the right to request the footage of all CCTV held with you in it (which would have to pain-stakingly be manually viewed to identify it and quite likely blurring occur of others to protect their rights to privacy before being handed to you, and all done at no expense to you and within a surprisingly tight time-frame - a.k.a. a subject access request (SAR).

For that reason, I'm assuming that most CCTV footage in a vets is wiped on a daily basis if no incidents have occurred? Otherwise it sounds like it would have the potential to cause significantly more headache than it could possibly hope to solve?

What should we do when we’ve received a subject access request for some CCTV footage?

You must give someone a copy of the footage if it contains their data, unless an exemption applies. If they agree, you can arrange for them to view the footage, rather than receiving a copy.

If the footage includes other people, you’ll probably need to redact (eg edit or blur) it so they can’t be identified. You should consider the level of harm for those people if you don’t redact. If you can’t redact the third party footage, you’ll need to consider asking for their consent before releasing it. Where this isn’t possible or appropriate, you must balance the requester’s rights against any third-party rights to privacy and decide if it’s reasonable to share the footage without their consent. You should look to disclose the personal data if you can, but it’s a balancing act. Document the reasons for your decision."

ico.org.uk/.../

RE: How do you react to an aggressive patient?

Clive Ansell — Thu, 07 Mar 2024 20:01:24 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243953#243953"]

Michael Woodhouse said:
What world do we live in where the vets are taped on CCTV?

The thought that went through my mind was that this must surely be quite commonplace these days, mainly to protect veterinary staff against threat or malicious complaint.

[/quote]

Or to spy/keep tabs on/micromanage staff? maybe?

I have been known to disconnect CCTV cameras before, I believe we have a right not to be filmed if we so wish?

I can understand them being used in areas where the public can go; consultation room, reception etc, and in areas that would be more at risk of break in or theft. I worked in a practice about 2 years ago that had a CCTV camera in the operating theatre, that had only one door and no windows.

[quote userid="2100" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243953#243953"]

Dinu Catilina said:
Now, if a dog tries to bit me I will restrain by all means necessary. My and my team safety should come first when handling animals so is it just me who finds this comment odd? Dogs, when nervous, will sometimes soil themselves in the kennel before we even touch them. Is this really a risk of injury?

Not that it matters, me being a layman and all, but yeah, I thought it was odd to evidence injury with soiling or 'stillness in the treatment room'

[/quote]

It's nonsense.

There are multiple resaons why a dog may soil itself or be still, it is not inself proof of unreasonable treatment. We are all faced with difficult patients from time to time, and using reasonable and proportional force to contain or restrain them is perfectly acceptable. I have had dogs seem to pass out and turn cyanotic being restrained with a dog catcher, but these are aggressive dogs where there is no other safe option.

How many dogs that are forcibly pinned into the table to clip their nails, that often don't need doing anyway, soil themselves and become still? Should they all be reported to the RCVS too?

It is impossible to commit on this case unless one was actual there to observe it; maybe he overstepped the mark, maybe he didn't and did what others would do - I don't know I wasn't there. We all have bad days where we are tired, stressed, or unwell, and this seems as it was an out of character one off event.

RE: How do you react to an aggressive patient?

Rob Loxley — Thu, 07 Mar 2024 19:38:05 GMT

The admission that “Whilst in the corner of the room, the Respondent hit Bella repeatedly, first with his hand, and then, with a muzzle that had been handed to him” concerns me, and I would presume the public too, and seems beyond reasonable défense against being bitten

RE: How do you react to an aggressive patient?

Dinu Catilina — Thu, 07 Mar 2024 18:42:54 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243953#243953"]Not that it matters, me being a layman and all, but yeah, I thought it was odd to evidence injury with soiling or 'stillness in the treatment room'[/quote]

I really don't want to comment on the case itself but like you pointed out about the odd DC comments. They remind me of the dog in the blanket comments during the Kikosi (possibly incorrect spelling) case.

[quote userid="2100" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243953#243953"]Specifically, the report stated that the dog 'went to bite' him. It hadn't actually bitten.[/quote]

Well, I hope I react before and not after I'm bit. Going for me or someone else is good enough to alter my behaviour and take precautions.

RE: How do you react to an aggressive patient?

Arlo Guthrie — Thu, 07 Mar 2024 17:36:44 GMT

[quote userid="3169" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243947#243947"]Absolute over reaction by the corporate owners and their management, did this need to go to RCVS?[/quote]

I didnt see in the report that it was the management that took the incident to the RCVS.

[quote userid="3169" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243947#243947"]What world do we live in where the vets are taped on CCTV? [/quote]

The thought that went through my mind was that this must surely be quite commonplace these days, mainly to protect veterinary staff against threat or malicious complaint.

[quote userid="3169" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient/243947#243947"] Dog had already bitten the vet.[/quote]

Specifically, the report stated that the dog 'went to bite' him. It hadn't actually bitten.

[quote userid="9239" url="~/f/non-clinical-questions/30909/how-do-you-react-to-an-aggressive-patient"]Now, if a dog tries to bit me I will restrain by all means necessary. My and my team safety should come first when handling animals so is it just me who finds this comment odd? Dogs, when nervous, will sometimes soil themselves in the kennel before we even touch them. Is this really a risk of injury? [/quote]

Not that it matters, me being a layman and all, but yeah, I thought it was odd to evidence injury with soiling or 'stillness in the treatment room'

Funny how it's all so culturally dependent. Here, if a human causes transient pain to a dog that was evidently trying to bite, they risk their career. Whereas in other cultures, the same dog would make a nice hors d'oeuvres.

RE: How do you react to an aggressive patient?

Michael Woodhouse — Thu, 07 Mar 2024 02:25:01 GMT

A carefully considered response is difficult here. Absolute over reaction by the corporate owners and their management, did this need to go to RCVS? Would a private practice ever report someone for such an isolated incident? What world do we live in where the vets are taped on CCTV? I imagine this may have looked distressing for the student nurse, but she would be FAR more distressed if she had gone and gotten the dog out of the kennel, properly introduced herself (!) and then been bitten in the face leaving permanent disfigurement. Dog had already bitten the vet. Unconvinced, any evidence of actual harm. Whist the oath puts animal welfare as our priority, the health and safety executive have very different views.

I'm reluctant to share anecdote, but we sometimes have to deal with very difficult situations the best we can. I would never work in a practice without a dog catcher, and I have seen cyanotic dogs through safe and appropriate handling, in the given situation. Never had a member of staff significantly injured, and that is my absolute priority. Sometimes these small dogs can be the worst.

(and I personally enjoy the challenge of a difficult patient. If I can TB test a 1.2 tonne angry bull, the grumpy dog is less scary).

I wonder how much this cost?