Below is an excerpt from the book “Confidence in Conflict for Healthcare Professionals: Creating an Environment of Care That is Incompatible With Violence” by Joel Lashley.

“Human nature is complex. Even if we have inclinations toward violence, we also have inclination to empathy, to cooperation, to self-control.” – Steven Pinker

I was passing through the Emergency Department when an  angry looking man walked in through the front door. He was a hard figure to miss. He wore a denim jacket with the sleeves torn off and emblazoned on his makeshift vest were the colors of a well-known and notoriously violent motorcycle gang. His bare arms were heavily inked with gang colors, lewd images, swastikas, and various weapons.

He was at least six and a half feet tall and easily weighed over 300 pounds. His long bushy hair flowed over his shoulders. His beard was equally impressive, reaching all the way down to his pistol- shaped belt buckle. His wide black belt was encrusted with pointed metal studs and a long heavy chrome chain secured his wallet to it. His jeans were tucked into his tall studded motorcycle boots, which could easily have concealed a knife or small-framed handgun.

The big man stood in the lobby with his feet apart, his huge    fists clenched, and wearing an obvious look of disgust on his face. Without saying a word, he commanded the room as all eyes were on him. Finally he shouted, “Where am I supposed to park my f***ing van?!” You could have heard a pin drop. Everyone in the room froze, staff and patients alike.

I was dressed in a suit and didn’t look particularly intimidating. Still, I decided to address the big man. I walked towards him with    a look of confident concern on my face, because when people are angry they don’t want to be smiled at. I didn’t stand directly in front of him. Instead, I stood about ten feet away with my feet apart and my hands out in front of me. At ten feet, I could quickly evaluate or exit the scene if he suddenly flew off the handle. As soon as I was in position, I began to speak.

“Hello, Sir. I’m Joel. I work here in the hospital.” Now the big man looked directly at me.  “I  can  help you with your van, but can I ask you not to yell or curse? There are kids and families around. Let me help you out.”  The man looked at me with an expression   of angry shock. In my peripheral vision, I could see nurses backing away and seeking safety. After a short pause, he spoke again. This time more quietly.

“Whatever.” he replied. “Where am I supposed to park around here? The lot is full.” Based on his initial reaction to me, I closed some of the space between us to about five feet so we could communicate more effectively without crowding each other. At five feet, I could more effectively communicate or evade an attack should things go badly.

“You’re in luck.” I answered. “Let me get a valet to park your car.

Valet service is free here.”

“I don’t want anyone driving my f***ing van!” he shouted back. “I don’t need anyone else in my f***ing van!” Clearly he wasn’t getting the message, so I continued.

“Sir, I have to ask you again not to yell or curse. There are patients and children around and this has to be a safe place for them. You’re a big guy and you’re scaring everybody. We can’t allow that in the hospital, so please stop.”

The big biker looked down at me and sighed, before answering me in a strained whisper. “Whatever. Where can I park, then?” Now satisfied that he was going to cooperate, I moved up within two feet of him so we could talk without compromising patient confidentiality. Two feet is  the  distance  at  where  I  could  operate or escape, if necessary. First, I asked him if he was in need of emergency care.  He explained that he was here to visit his son.        I asked him his son’s name and checked with the triage nurse to make certain the child was in the Emergency Department and that there was no dire medical emergency. The biker became visibly calmer, because information equals peace. One of the main reasons people act-out in clinical situations is fear or frustration linked to a misunderstanding or a lack of basic information.

Then came the hard part. I told him that, if he didn’t want to use the valet service, he would have to park several blocks away on the other side of the campus. He would then have to come through the main hospital entrance. Once there, he would have to get a visitor pass and directions back to the emergency department. Of course, that made him angry again. “Whatever. This is ridiculous,” he snarled under his breath, but this time without cursing or yelling. He then turned and walked back out into the parking lot.

Several minutes later the big, mean, angry biker appeared at the visitors’ center in the main lobby. There were a lot of people in line, so he soon lost his temper. “This is ridiculous,” he yelled! “How do  I get to the f***ing emergency room from here? I don’t have time  for this bulls***!” The security officer assigned to the hospital lobby overheard him and didn’t waste any time responding. Being mindful of his proxemics, i.e., managing his distance to the subject depending on the level of threat, he approached with caution and began evaluating the subject at ten feet away. When he was satisfied that the big biker was unarmed and not actively aggressive, he approached with caution up to five feet where he could communicate. Then he stood and spoke as trained.

“Sir, I’m Mark, with security”.

“So?” replied the biker, rolling his eyes.

“I will help you get to the emergency department, but please stop cursing and yelling. We have to keep things quiet and peaceful in the hospital for the patients.”

The big biker snarled back, saying “Are you for real?”

Now relaxed but ready at five feet away, the officer simply smiled and continued, “Look, you’re going to give some heart patient another heart attack! We have to keep things calm around here.”

To that, the big biker finally smirked and shook his head. Then he replied, using his word of choice. “Whatever. Just get me over there, will you?” The officer then stayed on track, now operating at two feet he made sure everything was in order before taking the biker to the Emergency Department.

“My pleasure. First we have to get you a pass. Who are you here to see today?” While the security officer assisted the big biker,  I   was waiting back at the Emergency Department to see what would happen when the big biker showed up again. When he finally arrived, it was the triage nurses’ turn with him.

“Hello, I’m Amy. I’m the nurse who is checking in your son. I have to ask you some questions about him. It should only take a few minutes. First, how do you spell his first name?”

The big biker looked annoyed again, “Are you kidding?  His name is Jerry.”

“Jerry or Gerald” she continued, unshaken.

The biker looked puzzled, “Uh, Gerald” “With a G or a J?” she asked.

“J, I think.” answered the biker, “Isn’t that in his records or something?”

“Oh sure,” said the nurse. “That is if he’s been here before. We need proper spelling to find his record or it will take much longer. Now, how do you spell his last name?” To that, the biker obediently spelled out the boy’s last name. Then she continued to question the biker, “Is he on any medications?”

“Isn’t that in the records, either?” he asked.

“Possibly, but your boy may have been prescribed new meds by his doctor, since he was last here. We need that information to keep him safe.”

The big biker answered, but continued to do what uncooperative people do. He challenged every question and resisted every step. In response, the nurse did what trained and capable communicators do when they meet verbal resistance: used Redirections. She was clearly a master of this tactic. She deflected all his resistance by acknowledging each question, while still keeping the biker on track. And she did it with one simple word, the word “but.”

When she was finished, she sent the biker over to registration. He refused to sit when the young registration woman offered him a seat, so she just started in with her questions. “How do you spell your child’s name?” The biker grew visibly annoyed again.

“Are you kidding? Can’t you just ask her?” while gesturing toward the triage nurse.

“Yes, but she’s with another patient right now. Can I just ask you for his name again, please? Then I can quickly verify his address   and insurance.” The young woman did a very nice job of using the Redirections tactic and keeping the biker on track, just as the nurse had done. All seemed to be going along smoothly, until the young woman advised him that he wasn’t the father of record. Finally, he began to shout again.

“That’s not right! I pay this kid’s bills!” Because the biker was shouting again, his behavior had to be readdressed. That said, there was still a noticeable change in the biker’s behavior. He wasn’t cursing. Even after this stumble, he was still actively modifying his normal behavior.

When he began to shout, the young woman rolled back in her chair a few feet and kept the counter between them, as trained.     She then replied by simply stating, “Sir, please don’t shout. There are sick people and kids around, and you’re making them feel unsafe.” Her expression was concerned  and  her  tone  of  voice was professional and confident. The biker stopped yelling, but continued in a low volume.

“That ain’t right!” he whispered hoarsely. The registration person also explained that, since he wasn’t a legal guardian or adoptive parent, he could not give permission to treat. The biker was now beside himself with anger. “I’m going to sue this place,“ he whispered angrily. “I can’t believe this!” His face was red and he pointed his finger at the registration person, as he raged on in whispered tones.

The registration person kept the counter between them and stayed out of reach, while he quietly vented. She empathized by saying, “I understand that you’re angry, but our hands are tied because it’s the law. Help me get a hold of his mother, so we can make sure he gets all the care he needs as quickly as possible. In the meantime, they will care for him as necessary, until we can get a hold of her.”

With that, the biker calmed down enough to answer the rest of her questions. She then gestured towards the waiting area and asked him to take a seat. But, if you know anything about tough guys, no one tells them to sit down, especially women! So he stood there like a statue, unmoving and waiting for someone to take him back in the treatment area to see his girlfriend’s son.

After a few tense seconds, the registration person simply looked up at the man and confidently stated, “Sir, can I ask you again to take a seat, please? I assure you that they will call you soon. I have other people waiting in line.”  At that, the biker looked around the room  at all the faces he hadn’t taken notice of before. Some of them were staring uncomfortably off into space. Others looked at him with a puzzled or disgusted expression. Then he simply turned, walked to the waiting area, and sat down.

With things settled down for the time being, I went back to      the treatment area to advise the medical staff about what had just transpired. They assured me that they would call security quickly if the man started up again, as his behavior had already been addressed several times. I then went on to my meeting.

A couple of hours later, I walked back to the emergency department to see how things were going. I asked the doctor how the big biker was doing. “He’s fine. No problems. You shouldn’t judge a book by its cover, you know,” he said smugly. I then went to the nurse who was working with the boy, his mother and the biker. She described the big biker as “pleasant.” When the biker left later that day, he stopped by the visitors’ center and apologized to the people working there, stating that he was sorry he’d behaved like a jerk. Then the formerly big, mean, angry biker, his girlfriend, and her son walked out towards the parking lot.

What could account for such a transformation? Was it his girlfriend perhaps? Not likely, she hadn’t shown  up  until  way after the biker had been given permission to see the boy.  The nurse also said he’d already become “pleasant” long before his girlfriend arrived. So then what could account for the change? Perhaps we can figure it out by asking what he may have been like, if he’d been handled a different way.

Would the biker’s behavior have changed,  if  I’d  ignored  him and allowed him to yell and curse? Would it have gotten worse or better? Perhaps I could have  told him just to leave his car parked   in a no parking zone and not to worry about it. That might have appeased him, until he got a parking ticket. Appeasement rarely works anyway. Mike Thiel, the Director of Security at Children’s Hospital of Wisconsin likes to put it this way: “appeasement equals encouragement for more bad behavior.” Also, mere appeasement doesn’t address the underlying problem.

When we fail to resolve problems, in favor of ignoring them, they usually become bigger problems. Still, this is the direction we usually go when we encounter anti-social and even threatening behavior in hospitals and clinics. We follow the path of least resistance to get the angry and threatening person out of our way; and following the path of least resistance almost always leads to failure.

What if when he questioned the triage procedure, the nurse offered to simply wait and ask the child’s mother when she arrived? Might that have worked? Or would she have placed the patient in greater danger, by not having timely information about medications, food intake, conditions, allergies, and etcetera? Also, that would be just more appeasement, i.e., more validation of the illusion that bad behavior gets results.

If the registration person had just let the biker vent, as she’d heard people say before, would he have gotten everything off his chest and been fine, or would his bad behavior have escalated? If at every step, the biker had been treated with kid gloves, given a wide berth, and killed with kindness—in other words, embraced all the advice nurses are given throughout their careers—would he have turned into this nice pleasant man they encountered in the treatment area or would he have been something entirely different?

In reality, he would have been taken down a path towards violence. He would have continued to be loud, obnoxious, and threatening. As a result, other patients and families would have been disturbed, the emergency medical staff would have become fearful, and the patient would have been over-stimulated.  When  other  patients  and families are disturbed, they complain and even consider going elsewhere for their medical care. When medical staff becomes fearful, they experience more stress and many consider seeking new employment. Worst of all, medical staff may spend less time with patients and make more mistakes. The hospital loses, the staff loses, and patients lose.

Appeasement in the face of anti-social and threatening behavior is the path we most often take in human service work, all because of a mythology that exists about violence in our workplace and how it should be handled. That is, a mythology that directs us to legitimize and even reward anti-social and threatening behavior. What are these myths? Why do we continue to embrace them and pass them on, even in the face of so many failures? First we need to recognize what these myths are, before we can go in another direction.

Also, we have to ask ourselves, does the biker behave this way in all situations and in all places? Would he have behaved the same way in a church or a library? Perhaps, but it’s not a foregone conclusion. Can we assume that, if he behaved that way in a library or church, he wouldn’t be welcome there?

So what made the intervention with the angry biker successful? What stands out most is the consistent response from the staff. Inconsistency is the enemy of peace. Consistency, on the other hand, is the basis for all successful intervention and the ultimate exclusion of unwanted behavior within a relationship or group.

The “Big, Mean, Angry Biker” story is just one of thousands from my thirty-plus years of work in public safety. I’ve repeatedly encountered people just like him and I’ve seen the good the bad and the ugly that can result from the wide range of approaches used to address challenging behaviors like his.

To learn more about how you can learn to employ these tactics in your organization, click here.