Managing discrimination from patients and their guardians and relatives

Steps for any worker

Location: UK
Audience: All doctors
Last reviewed: 1 March 2022
Topics: Equality, diversity and inclusion

The following section sets out steps that should be taken when an incident of abuse, harassment or unlawful discrimination on the basis of a protected characteristic occurs.

These steps can be taken by any worker in a position to do so:

  • the healthcare professional on the receiving end
  • other workers who are bystanders/witnesses
  • clinical managers, site managers, security, senior managers, etc).

However, ultimately it is the duty of senior leaders to ensure that policies are adhered to, and that the healthcare worker is protected.

When a patient requests a healthcare worker with a particular characteristic

If a patient (or their guardian/relative) requests a particular personal characteristic that appears to be on the basis of unlawful discrimination, potential responses include:

(See section 5: 'Exceptions for situations when a request for a particular characteristic might be lawful and valid').

  1. Immediately engage with the individual who has displayed discriminatory behaviours – in your communications use language and tone that is clear, calm and objective.
  2. If possible, ask the patient (or their guardian/relative) why they are making that request.
  3. Tell the individual that their behaviour is unacceptable in this healthcare environment. Be specific and give examples of their language/behaviours that were discriminatory or inappropriate.
  4. If the request appears to have no reasonable merit (see section 5), advise patients (or their guardians/relatives) that these requests cannot be accommodated.
  5. Inform them that the available health and care professional is capable of delivering their care.
  6. If the patient agrees to remove their request – consult with the healthcare professional. Colleagues/managers should not assume that the professional will not be willing to continue to provide care, but should make clear that if they wish to withdraw on wellbeing grounds, that this will be respected.
  7. If patients (or their guardians/relatives) insist on their request, advise them of the likely impact on being able to receive care at that organisation, their right to seek care elsewhere and the process involved in seeking care at another provider. Additionally, there may be certain situations where a professional decision can be made based on duty of care for the patient, to remove the guardian/relative displaying the behaviours and continue treatment of the patient.
  8. Carefully document such a refusal to confirm that the patient truly understands the risks, benefits, and alternatives to their request.

Abuse, harassment and hate crime

When a patient (and their guardian/relative) is abusive (physically or verbally) take the following steps:

  1. Make the environment safe. This may mean calling the police or security services, removing the perpetrator from the environment and consider moving the person who is receiving the abuse to a safe space temporarily for their protection and wellbeing.
  2. Immediately engage with the individual who has been abusive, telling them that their behaviour is unacceptable in this healthcare environment. Be specific and give examples of their language/behaviours that were abusive.
  3. Consider the following immediate options:
    a. Ask the individual to leave immediately (backed up by police or security if needed).
    b. Tell them that they will have to adjust their behaviours or they may be asked to leave the service.
    c. Advise them of their right to seek healthcare elsewhere but that all employers do have a duty to protect their staff from abuse.
  4. If the patient is having emergency care or does not understand the situation due to an underlying pathology, consider how to revisit the conversation at a point when they may be able to understand (this could include sending a letter at a later date when they are no longer in care). See section 5 'Exceptions' for more information on this.
  5. Carefully document the incident and actions taken. Write objective facts and observations, avoid noting subjective opinions. See annex 1 on monitoring in the model policy.
  6. Additional steps to consider:
    a. Ban the individual from the department or use a behavioural agreement for future encounters.
    b. Report the behaviour to the police if it is deemed to be unlawful discrimination or hate crime.
    c. Complete an internal incident reporting form.

Healthcare workers on the receiving end of the incident

When faced with incidents of harassment on the basis of your personal or protected characteristic, consider taking the following steps. If you have witnessed an incident these steps might also be relevant, as witnessing an incident could also have significant impact on a healthcare worker.

  1. Talk to your colleagues and managers about your concerns and the impact of the incident on your wellbeing.
  2. Contact the BMA (if you are a doctor), your union, staff support networks and employee assistance programmes for advice and wellbeing support.
  3. Advise your employer of their duty of care to take steps to protect you from abuse.
  4. Consider what steps you would like the employer to take and share these options with them.
  5. Share this guidance and model policy with your employer.
  6. If no action is taken, consider making a complaint through formal complaints and grievance procedures. Seek advice on how to do this through the organisation’s human resources department and your union representatives, such as the BMA.
  7. Document all incidents with dates, times, people involved, and actions taken.