External controlling factors may be related to the clinician, the health care setting or to other people such as family and friends. In the few circumstances in which it is acceptable for clinicians to use force, the least restrictive technique possible should be preferred. For example, if a patient is at immediate risk of harming himself or herself, simple observation in a supervised environment, rather than physical restraint or sedation, may be sufficient. Similarly, an elderly patient with delirium who is falling out of bed can be moved to a mattress on the floor so that the risk of falling is eliminated without physical restraint. Clinicians can also take steps to minimize the coercive nature of institutions by enhancing the patient's sense of choice.
Clinicians can also take steps to minimize the potential for manipulation.
First, because patients can be manipulated when the information they receive is incomplete, clinicians should ensure that adequate information has been disclosed to the patient. Second, manipulation can occur when information is presented in a biased fashion. A useful strategy is to ask patients to review information in their own words. The cases The surgeon tries to determine why Mrs. K is climbing out of bed. The relative reassures Mrs. K that a neighbour has been feeding the cat.