USA Today op-ed: Violence against doctors and nurses due health care dysfunction

My latest column was published this morning in USA Today: Violence is symptom of health care dysfunction.

I discuss the disturbing trend of violence against health care workers.  Here’s an excerpt:

Violence is most common in psychiatric facilities and emergency departments, but can also be seen in waiting rooms, long-term care facilities and critical care units. Nurses are the most frequent targets. According to a 2010 survey from the Emergency Nurses Association, more than half of emergency room nurses were victims of physical violence, including being spit on, shoved, or kicked, and one in four reported being assaulted more than 20 times over the past three years. The survey noted that the violence appeared to be increasing at the same time the number of alcohol-, drug- and psychiatric-related patients was rising.

Clearly, we must do better protecting those charged with healing the sick.

Enjoy the piece.

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  • Wendy Burnett

    Violence is never an acceptable choice, except in cases of self-defense; but I do understand the frustration of the patients who lose control. My last experience with the healthcare system was bad enough that I will literally stay home and die before I go back to the ER at one particular hospital in my area.

    I spent 13 HOURS sitting in the waiting room bleeding internally, then spent another 12 hours or so in the exam room waiting to be admitted. The doctors and nurses were rude, and treated me like a drug-seeking addict, even though all my bloodwork came back clean of anything except ibuprofen; and they never bothered to even ASK if my chronic issues had been diagnosed by a doctor until the day I left, instead assuming that I was either lying or self-diagnosed. The doctor ordered Ultracet for my fibromyalgia pain, but the nurses refused to give it to me, and only ONCE in the entire time I was there did they even offer to give me Tylenol instead.

    I was lied to, verbally abused, and accused of being an addict by several of the nurses I was assigned to over the four days I was an inpatient. With that kind of treatment by people who are supposed to be taking care of you, is it really surprising that some patients lose their tempers and attack their nurses and doctors?

    If you expect to be treated with respect, you better learn how to treat others respectfully. Patients are not stupid, are quite capable of participating in the decisions relating to their own care, and have a right to be treated as human beings. Assuming that patients are lying, and treating them based on that assumption, not only makes for lousy care; it makes for a lousy human being, with no compassion or understanding for the patients they treat.

    I’m not saying that all doctors and nurses are horrible people who deserve to be abused, simply that they need to take a look at their own behavior and attitudes and realize that there may just be a correlation between the way patients are treated and the increase in attacks on healthcare workers.

    • Dr. J

      Your attitude is the reason why assault of health professionals is now considered to be normal. You seem to be saying violence is not okay unless the patient gets mad enough and then it becomes acceptable.

      Where do you work Wendy? Is it okay to come into your workplace and yell, swear and hurt you? What about if I do not like the service you provide, or if you tell me that you cannot do the service I want, is it then okay? No it’s not okay. Why do I not have a right to work in a safe place, and why do I have to accept that from time to time I will get hurt by some angry person, often angry at something that has nothing to do with me (like how long they waited)?

      Last week in the midst of a chaotic emerg I walked in to some old lady’s room to see her and her son (a local professional) stood up and said ‘I’m going to punch you right in the face for making us wait like this!’ before I had even said a word. I left and called the police. I have in fact been attacked by patients, and hurt by patients before I will do everything I can to avoid it happening again.

      Here’s my policy: When a patient, or the family member of a patient threatens me or assaults me the relationship between us as doctor and patient is terminated. You will need to go register again and be seen by another doctor if you wish but I will not provide you with care. I will notify the police that you have threatened me or assaulted me and I will make sure they know that I will be in court to testify when the case comes up. I will make a note in your record that you are violent, and ensure that police or security are with you whenever you are in the hospital ever-after.

      Now you will say ‘What if the person has a serious condition!? You could miss it. They could have a bad outcome!’ The answer is, it’s too bad that the violent actions of the person caused them to have a delay in care but actions have consequences. My tolerance for patients who are violent towards me, or who threaten me with violence is zero. Hurting another person, and even threatening to hurt another person is a criminal action, and it should be treated as exactly that.

      • Wendy Burnett

        Dr. J

        If you will reread my first sentence, you will see that I EXPLICITLY state that violence is never acceptable except in self defense. I am simply saying that the way patients are treated can be a contributing factor in the increased violence against healthcare workers.

        Nowhere in my comment do I say that attacking ANYONE is acceptable behavior, nor do I say that those who are attacked are personally at fault. In addition, I don’t even SUGGEST that someone who attacks a heathcare worker shouldn’t be prosecuted, or that someone who is attacked shouldn’t file charges. You have every right to a safe workplace, just as anyone else does, and how you deal with the threat seems perfectly appropriate to me.

    • patient advocate

      I am sorry to hear that you had an experience like that and that doctors and nurses were rude to you. On the flip side I have never been rude to a patient, yet at times have been treated horribly by patients. Does that make it ok to generalize all patients the same way? You have lumped all doctors as one and I think such generalizations are inappropriate.

      Do you know what its like to dedicate your life to helping people, work as hard as you can, be as kind as you can to your patients, yet never meet the expectations of many patients? In fact, some patients downright will treat me like crap? Fortunately there are some patients who appreciate you and make it all worth it. There are complex strains on the system and unfortunately some people dont understand that. This is a very good article that addresses how both doctors and patients can adjust their behavior.

  • Reasonable Patient

    This is a really sad post, and I’m thinking about it in light of the previous articles about malpractice. My gut feeling is that “health care dysfunction” is a reason that many patients with drug/alcohol and psychiatric problems are not being adequately treated. There’s not enough time, continuity of care, etc.

    The idea that patients without these problems (I’m thinking of organic brain disease in which someone is really not in control of their behavior) feel entitled to violence because of the stresses caused by our healthcare system is really disturbing.

    I hate the way patients are infantilized by the healthcare system, the way we’re so often not taken seriously, or are treated as though we’re inherently worth less than doctors. However, my strategy has been to learn to speak up politely like the adult I am, rather than acting out. This may not always be successful, but I just can’t imagine spitting on a nurse because I “had to wait”. There’s no excuse for that, and I’m so sorry that any of you have to go to work each day being afraid of that, or worse.

  • benzonit

    As a front line worker in the ER for 25 years, might I offer a simpler reason for a perceived upswing in violence?

    We’re not doing our jobs because our tools have been taken away from us.

    I trained in the Detroit area in the mid-80′s, a violent time, to be sure. We had a few simple rules: It is true that any one can come in any time with any complaint at any hour and receive care. That person does not have the right to disrupt the care of any other patient or threaten in any way a health care worker; to threaten a health care worker in the ER was to threaten the access to health care for the entire community served. Additionally, the other patients had a reasonable expectation to not be assaulted verbally, visually or physically. In other words, our job was to preserve the normal borders.

    In recent years, methods that we had used to protect the patient from themselves, other patients and the health care workers (restraints, meds) are now not available by fiat from regulatory agencies. (I’m sure these same agencies expect these protections for themselves and their families.)

    Thus, when a violent patient is brought in, making threats physical, verbal and visual against the health care worker and other patients, we and our security staff are instructed not to follow best medical practice (Get the Drugs in and the Cops Out) or restrain physically if need be. Instead, we are to use a prescribed set of rituals, which often result in the patient striking out at staff (endangering staff and other patients) or hiking out, endangering themselves or strangers.

    We even have laws requiring us to hold prisoners, without means to do so, after they have been released. (See Iowa’s Ed Thomas law:

    Perhaps permitting us to do a job no one else wants will permit us to protect ourselves, our dependent patients, and, likely most importantly and forgotten, the folks who are themselves the violence perpetrators.

  • Dr. L

    I appreciate your perspective, but as an emergency room psychiatrist I don’t understand using statistics that include incidents with psychiatric patients to make your point. We are yelled at ever day and threatened ever day. It is part of the job and that behavior is often (though not always) a symptom of what we treat. You write:

    Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.

    Unlike other parts of medicine, our first concern is for the safety of staff and patients. Metal detectors are vital. We treat very psychotic and paranoid patients ever day who are often intoxicated. I appreciate the point you are making, but events in psychiatric settings have different causes and should not be lumped in with general trends of violence in healthcare settings.

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