You have both a right and a professional obligation to maintain a safe practice environment. When a patient is threatening or violent, you can end the consultation immediately, call police if safety is at risk, and begin the process of ending the therapeutic relationship. You do not have to tolerate abuse. Document everything from the first incident.

Reports of threatening and aggressive behaviour toward medical practitioners and practice staff have increased significantly in recent years. From verbal abuse and threats during consultations, to sustained harassment campaigns via email and social media, to physical intimidation in waiting rooms — these situations create serious risks for doctors, their staff, and ultimately patient care.

Many practitioners feel trapped: they want to maintain their duty of care, they are worried about complaints, and they are unsure of their legal rights. This guide sets out clearly what you can do — and what you are entitled to do — when faced with a threatening or aggressive patient.

Understanding Your Workplace Safety Obligations as a Doctor

This means:

You have a positive obligation to implement systems that reduce the risk of violence in your practice

This includes having policies for managing aggressive behaviour, training staff, and maintaining a safe physical environment

If you are a practitioner working within a hospital or large practice, your employer has obligations to you under the same framework

Immediate Response: What to Do When a Patient Becomes Threatening

In the moment, your priority is the safety of yourself and everyone in the practice. The steps below apply to an acute threatening situation:

Step 1: Prioritise Safety — End the Encounter

You are not required to continue a consultation with a patient who is being threatening or violent. You can say, clearly and calmly: ‘I need to end this consultation now. Please leave the practice.’ You are entitled to physically leave the room if necessary.

Step 2: Alert Staff and Activate Your Safety Protocol

Every practice should have an emergency protocol for threatening situations. Staff should know the signal, know to call for help, and know not to escalate. If you don’t have a protocol, this is a priority to establish.

Step 3: Call Police if There Is a Risk to Safety

If a patient is physically violent, has made a credible threat of violence, or will not leave the premises, call police. You are not overreacting — this is appropriate use of emergency services.

Step 4: Document Immediately

As soon as the immediate situation is resolved, document in detail what occurred. Use your clinical notes and, if your practice has an incident reporting system, complete that too. The contemporaneous record is your most important protection for any subsequent complaint or legal matter.

Clinical Scenario: Threatening Consultation Dr Abara is in a consultation with Mr Frost, who has presented demanding an opioid script. When Dr Abara declines, Mr Frost becomes verbally aggressive, stands up, and says: ‘You’ll regret this. I know where you live.’ Dr Abara feels genuinely threatened.

What Dr Abara should do: Calmly end the consultation. Leave the room if necessary. Ask reception to contact security or police. Do not attempt to continue the consultation. Document the exact words used. Call her medico-legal insurer. Consider whether to report to police (a direct personal threat may constitute a criminal offence). Begin the process of formally terminating the therapeutic relationship once the immediate situation is resolved.

Your Right to Refuse to Treat — and Its Limits

You are entitled to refuse to treat a patient who is behaving in a threatening or abusive manner during that encounter. You do not have to accept abuse as part of your professional role. However, the duty of care does not completely disappear the moment a patient becomes difficult — there are limits:

You retain a duty to provide emergency care even to a threatening patient, if their life is at risk

You should not refuse to complete treatment mid-procedure in a way that would itself cause harm

Refusing to treat for discriminatory reasons (e.g., because a patient has a mental illness) is not justified by the safety exception

The Pattern: When a Single Incident Becomes Ongoing Harassment

Some of the most serious situations arise not from a single explosive incident, but from a sustained pattern of harassment — repeated threatening emails, abusive calls to staff, threatening online reviews, or persistent attempts to intimidate after a clinical decision the patient disagreed with.

Documentation Is Everything

Every incident, no matter how minor it seems, should be documented. Your documentation should include:

The date and time of each incident

The exact words used (in quotes where possible)

The medium — in-person, phone, email, social media

Who witnessed it

Any action taken in response

Clinical Scenario: Sustained Email Campaign – Following a decision to refuse ongoing Valium prescriptions, a patient — Mr Kelley — begins sending Dr Park multiple emails per week. The emails start as complaints but escalate to threats: ‘I’m going to destroy your reputation,’ ‘I have a lawyer,’ ‘I’ll make sure every patient knows what you did.’ Reception staff are also receiving abusive calls.

What Dr Park should do: Print and save every email. Log every call. Respond once (or have her practice manager respond) in writing, stating that the behaviour is unacceptable and will not be responded to further. Do not engage with the substance of the threats. Send a formal termination letter. Notify her medico-legal insurer. Consider whether the communications constitute criminal harassment and whether a report to police or an application for an apprehended violence order (AVO) is warranted.

Legal Remedies Available to Doctors

1. Apprehended Violence Orders (AVOs) / Restraining Orders

2. Reporting to Police

Where a patient’s conduct constitutes a criminal offence — threats to kill, property damage, stalking, or harassment — reporting to police is appropriate. You have the same rights as any member of the public in this regard. Your medico-legal insurer can guide you on when this step is proportionate.

3. Civil Injunctions

In serious cases of sustained harassment — including coordinated online attacks — courts can grant injunctions restraining the conduct. This is a more involved legal process but has been used successfully in cases involving medical practitioners.

4. Termination of the Therapeutic Relationship

In most cases, the most practical and appropriate response to ongoing threatening behaviour is to end the clinical relationship. See our dedicated guide: How to Legally Terminate a Doctor-Patient Relationship.

Protecting Staff: Your Obligations as Employer

If you are a practice owner or principal, your obligations extend to your staff. Under Work Health and Safety law, you must:

Have a documented procedure for managing aggressive patients

Provide staff with training on de-escalation and personal safety

Ensure staff can easily summon help during a threatening situation

Investigate and record all incidents involving staff

Support staff who have been subject to threatening behaviour — both practically and in terms of any WorkCover obligations

A significant proportion of threatening behaviour in general practice is linked to requests for controlled medications — particularly opioids, benzodiazepines, and stimulants. When a patient becomes threatening specifically in response to a prescription refusal, additional considerations apply:

Your clinical decision to refuse a prescription is a professional one — you are not required to prescribe because a patient demands it

Forged prescriptions should be reported to police

If you believe a patient is at risk of harm due to their substance dependency (not as a result of your clinical decision), a duty of care consideration may arise separately from the threatening behaviour

Frequently Asked Questions

Q: Will I face an AHPRA complaint if I refuse to see a threatening patient?

Potentially — some patients do lodge complaints after being refused ongoing care. However, a well-documented history of threatening behaviour and a properly conducted termination process significantly reduces your risk. If a complaint is lodged, your documentation and the formal process you followed are your best defence. Contact your insurer immediately if a complaint arrives.

Q: Can I tell the patient’s new doctor about their threatening behaviour?

Yes — but carefully. You have a professional obligation to provide a clinical handover when a patient transfers care. This can and should include safety-relevant information, including a history of threatening behaviour toward staff. Frame it as clinical information, document that you have disclosed it, and keep it factual.

Q: A patient has threatened to report me to AHPRA if I don’t give them what they want. How do I handle this?

This is one of the more common forms of patient coercion. Your clinical decision must be based on clinical grounds — not on the threat of a complaint. If a patient follows through and lodges a notification, a demonstrably coercive context will be relevant to how the complaint is assessed. Document the threat. Make your clinical decision on clinical grounds. Notify your insurer.

Q: What about patients who are threatening because they are mentally unwell?

Mental illness does not remove your right to personal safety. However, it may affect how you respond — in particular, whether the appropriate response is a safety referral or involuntary assessment rather than (or in addition to) termination of the relationship. If you believe a patient poses an imminent risk to themselves or others due to mental illness, contact the relevant mental health crisis team or emergency services. educational purposes. However, disclosure of identifiable information — even of a deceased patient — for educational purposes without explicit prior consent is problematic. If in doubt, de-identify thoroughly or seek ethics approval.

This publication is general in nature and is not comprehensive or constitutes legal or medical advice. You should seek legal, medical or other professional advice before relying on any content, and practice proper clinical decision making with regard to individual circumstances. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgment or seek appropriate professional advice relevant to their own particular practice. Compliance with any recommendations will not in any way guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional or practice. Tego Insurance Pty Ltd is not responsible to you or anyone else for any loss suffered in connection with the use of this information.

All content on this page has been written in a generic way, and has not been presented with any knowledge of your personal objectives or financial needs.