Table 1
The Universal Upset Person Protocol

Step 1 Recognize that the person is visibly upset
Step 2 Verbally acknowledge that the person is upset. (“You sound/look really upset.”)
Step 3 Let them identify their feeling (“You bet I am” or “No I’m not…I am angry/frustrated…”)
Step 4a Say, “Tell me about it” or “Tell me what happened.”
Step 4b Really listen as they tell you and try to understand their viewpoint
Step 5 When they are done, look them in the eyes and say, “I am so sorry that happened” or “I am so sorry you feel that way.”
Step 6 Ask, “What would you like me to do to help you?”
Step 7 Tell them what you suggest be done now
Step 8 Thank the person for being open with you
Step 9 Move on (You have now “cleared the air” with the patient and you can now move on to the reason for their visit)

Dike Drummond, MD. Available at:

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Table 2
Establishing Clear Policies

• Prescription refills
• Pain medications
• Behavioral expectations
• No show/same day cancellations
• Patient lateness to appointments
• Patient termination policy

Karen Broquet, MD, MHPE

Table 3
Warning Signs of Violence

• Yelling, talking loudly
• Using profane/overtly sexual language
• Demanding unncessary care
• Accusing caregivers of conspiracy
• Darting eye movements
• Clenched fists or jaw
• Throwing objects or punching walls
• Inability to comply with directions
• Agitation
    o Can range from anxiety to aggression
    o Connected to many underlying conditions (most/all with slowed cognitive processing)
    o Repetitive non-goal-directed motor activity
    o Repetitive thoughts
    o Irritability
    o Heightened sensitivity to stimuli

Karen Broquet, MD, MHPE