In a survey conducted by the American College of Emergency Physicians (ACEP), almost half of surveyed physicians shared that they had been assaulted, and more than 70% had witnessed an assault in their workplace.1 Once revered and idolized by society and patients, physicians are increasingly being subjected to verbal and physical violence at work.
According to Ryan Stanton, MD, FACEP, an emergency physician at Baptist Health Lexington in Lexington, Kentucky, and spokesperson for the ACEP, “Violence [against physicians] is on par with many front-line industries. It is probably similar to emergency medical service folk and likely less than law enforcement, but still much higher than most professions, especially in the emergency department.” A review on workplace violence against US healthcare workers supports this, highlighting that, “the health care sector is statistically among the industries most subject to violence in the United States” and that “nearly 75% [of workplace assaults] occur in health care settings.”2
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The Nature of Violence
Physicians face violence that ranges across a spectrum, from verbal abuse and threats to physical assault, including assaults with weapons. Nearly half of the emergency physicians who responded to the ACEP survey reported being hit or slapped. Respondents also reported being spit on (30%), punched (28%), kicked (27%), scratched (17%), and bitten (6%). Dr Stanton recalled being “assaulted, threatened, and many times verbally abused.” He has also been “kicked, slapped, bitten, and grabbed.”
Physician Vulnerability to Violence
Most studies focus on violence against physicians in general, but is there a difference in the incidence of violence among medical subspecialties?
“I believe that psychiatrists are much more susceptible to physical violence,” opines Dr Michael David Sy, a physician at a private hospital. According to a study that examined the escalation of violence in healthcare settings, “psychiatry was the single most likely specialty of the victims (37%).”3 Psychiatrists work in a profession where dealing with aggression has become part of the job description, and these physicians face substantial abuse and physical violence that often goes unreported.
Similarly, physicians working in the emergency department face violence regularly and with increasing frequency. A recent study published in the Annals of Emergency Medicine indicated that violence in the emergency department is quite common, and that, despite raising awareness and other steps taken to reduce its occurrence, the incidence of physical assault has increased from 28.1% in 2005 to 38.1% in 2018.4
Other physicians are also targets of violence. For instance, there have been multiple reports of aggression against physicians performing abortions. The 2016 National Clinic Health Survey released by the Feminist Majority Foundation reports an alarming 34.2% incident rate of violence or threats of violence against women’s health clinics in the first half of 2016.5
Trigger Points for Violence
Assaults by patients and their families are the major causes of violence against physicians. Physicians in the emergency department often face patients who have been injured after a fight or who may be intoxicated. These patients and their families may already be in a state of acute stress and are more likely to be aggressive toward physicians when they are made to wait or when they think they are not given adequate care.
According to Dr Sy, “There were times where I was being told that I wasn’t doing my job as a physician. Usually, these are times when there is little to be done, as with patients who arrive in the hospital already dead.” The attitude of a few patients who “think that hospitalization is free, and a few [who] think that everything is an emergency” often leads to verbal abuse of the physicians who try to correct them of mistaken notions, Dr Sy added.
Problems with mental health, substance abuse, and stressful conditions such as long waiting times, crowding, or being given bad news may also contribute to violence.6
The Aftermath of Violence
When subjected to physical violence, physicians can lose work time for recovery. They may also have mental trauma and often experience fear, anxiety, and loss of concentration at work.2 This has an adverse effect on patient care. Indeed, the majority (77%) of ACEP-surveyed physicians feel that violence in the emergency department has affected patient care because it leads to a loss of productivity, emotional stress, and increased waiting times.1
Dealing With Workplace Violence
Given the prevalence of violence against physicians, it is important that this behavior be addressed, both at the personal level by physicians, and at the policy level by employers and the government.
Dr Stanton described a few basic precautions can help physicians avoid a potentially violent situation: “Don’t let anyone get between you and the door in a patient room. Always be alert and aware. If someone is getting agitated, get help and don’t be afraid to have others go in a room with you. Get security, and potentially police, involved early.”
In terms of employers and workplaces, according to Dr Stanton, “Safety of the staff needs to be a primary priority of hospitals. Physicians and staff need to have training in self-defense if they desire it, and hospitals need to support staff when they must protect/defend themselves. Authorities also need to prosecute offenders to the fullest extent of the law.” Dr Sy added, “The deterrent presence of a security guard in hospitals is helpful with regard to screening mentally unstable patients.”
The Joint Commission, a US-based nonprofit that accredits US healthcare organizations and programs, suggested the following actions to deal with violence6:
- Clearly define workplace violence and enable systems for easy reporting
- Put in place protocols and training programs to deal with violence
- Provide support, including counseling, to victims
- Identify and address contributing factors
- Make changes to the physical environment and workplace practices to improve physician safety
“All states need to have laws making assault of a healthcare worker on par with domestic assault,” Dr Stanton urges. “In Kentucky, the law has changed and [perpetrators of violence] can be arrested on probable cause or reported assault of a healthcare worker.”
Violence against physicians is an increasing reality that cannot be ignored. Along with empowering and enabling physicians at a personal level, the immediate attention of employers and law makers is required to address this increasing trend against a community of people who are simply trying to help those in need.
References
- Marketing General Incorporated. ACEP Emergency Department Violence Poll Research Results. http://newsroom.acep.org/download/ACEP+Emergency+Department+Violence+Report-10032018.pdf. September 2018. Accessed December 15, 2018.
- Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;374:1661-1669.
- Knable M. Homicides of physicians and mental health workers. Schizophr Bull. 2018;44(Suppl 1):S274.
- Omar H, Yue R, Amen AA, Kowalenko T, Walters BL. Reassessment of violence against emergency physicians. Ann Emerg Med. 2018;72(4):S144.
- Feminist Majority Foundation. 2016 National Clinic Violence Survey. https://feminist.org/anti-abortion-violence/images/2016-national-clinic-violence-survey.pdf. February 2017. Accessed December 17, 2018.
- The Joint Commission. Physical and verbal violence against health care workers. Sentinal Event Alert. https://www.jointcommission.org/assets/1/18/SEA_59_Workplace_violence_4_13_18_FINAL.pdf. April 17, 2018. Accessed December 17, 2018.
