Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When patients abuse emergency department workers

Jonathon Savage, DO
Conditions
February 16, 2014
509 Shares
Share
Tweet
Share

There are few professional careers centered around protecting and caring for others that garner so much verbal and physical abuse than a career in emergency medicine.  Mental health workers, police, fire, and EMS personnel are the other fields that come to mind when I think of a service that “helps” people yet gets abuse dished upon them on nearly a daily basis.

A 2006 survey of emergency nurses showed that 25% of nurses “seldom” or “never” feel safe at work.  The emergency department has the highest volume of reported cases of abuse of any segment of the healthcare setting.   It is generally accepted that the abuses are significantly under-reported because this abuse is just considered part of the job.  I know that I and most of my co-workers never report the abuse that we receive.

From first-hand experience in our high patient volume emergency department, I can tell you that it is nearly daily that I am verbally abused by at least one patient, sometimes more.  Attempts at physical abuse come less frequently but not infrequently.  Patient’s have attempted to hit, kick, bite, scratch, and spit.  By far, the vast majority of cases of verbal and physical abuse come from the drug and alcohol intoxicated, the psychiatrically impaired, and the demented.

Incidents of physical abuse are more common than you might think.  In various surveys, the level of verbal abuse and threats against emergency department healthcare workers seems consistently high.  I did not find one where that rate was less than 60%.  But more surprising was the rate of physical abuse.  Reported physical abuse occurs in a widely varying but nonetheless high rate somewhere in between 25% and 57% of respondents to these surveys.  In one study of 242 employees there were 329 reported cases of verbal and/or physical assault.  Most of which went unreported to hospital or emergency department administration.

I have witnessed a physician colleague of mine get pummeled by a patient for no apparent reason,  I have seen multiple nurses go out of work due to injuries suffered at the hands of patients.  And I have even seen a patient attempt to start the emergency department on fire by lighting up the hospital bedsheets.

A recent harm threat that I received was from a gentleman who after stating “you will see what it is like to be in pain” stood at the nurses desk and whispered to me as he pointed toward the exit door: “I will be waiting for you outside after your shift ends.”

From 1980 -1989, 22 physicians were killed while at work.  More recently in November 2013, a Dr. Stephen Larson was shot and killed by a man disgruntled about the care his mother received.  And in December 2013 a urologist in Nevada was killed by one of his patients and one of the other physicians in the office was critically wounded.

But what I want to talk about are the patients who are nice as can be when sober, mean as can be when not.  My general line of thought is that I am perfectly ok with mild to moderate drug and alcohol use.  But if you end up in the emergency department, and sometimes multiple times, due to your drug and/or alcohol use, then it is obvious(to me) that you are doing something wrong.

I am usually quite disturbed by the intoxicated patient who comes in tied down to the stretcher, using all sorts of profanity, spitting, and trying to swing at nearly anyone who gets within an untied-arms reach.  Then, miraculously, hours later they are sweet as pie.  Often quite apologetic for their behavior and sometimes telling me about their family and asking when they can be released because they have to be at work in a few hours.

How is it that these normally good people, turn so ugly with drugs or alcohol?  I know that drugs and alcohol change your perception, change emotions, disinhibit people, and alter impulse control.  I usually forgive the young teenager who went a bit overboard with their experimentation.  But adults whom I know have been down this path before.  They are not so easy to understand.

I recently watched a TED talk by Philip Zimbardo about the “Psychology of Evil.”  In that episode, Mr. Zimbardo stated that there are true “bad apples,” but these true sociopaths only make up less than 1% of the population.  There are also “bad apple barrels,” which would be the environment or conditions that the people are under that make them do things that they normally would not do.  And finally, there are “bad apple barrel makers,” which would be the system that allows the bad environment to exist.  This system could be a family, a business, or a government that allows, promotes, or creates the conditions that lead to a bad environment and bad behavior.

So when it comes to this completely inappropriate behavior that occurs with drugs and alcohol, I understand that most of these people are not actually bad people.  Many are in a bad environment that induces such behavior.  But if the behavior is induced purely by the environment of being marinated in drugs or alcohol, then it seems that this environment needs to change.

I am not suggesting a prohibition-like state by any means. That would be addressing the apple barrel makers.  While I think improved enforcement and education for sober driving and “healthy” substance use is warranted, what I am suggesting is some personal responsibility to fix the bad apple barrel — to address the circumstances.

As I mentioned, if you are ending up in emergency rooms due to drug and alcohol use, you are doing something very wrong.

Jonathon Savage is an emergency physician who blogs at Medical Mojo.

Prev

Why I am grateful for Match Day

February 16, 2014 Kevin 0
…
Next

Entering the exam room without the weight of the computer

February 16, 2014 Kevin 6
…

Tagged as: Emergency Medicine, Psychiatry

Post navigation

< Previous Post
Why I am grateful for Match Day
Next Post >
Entering the exam room without the weight of the computer

More by Jonathon Savage, DO

  • a desk with keyboard and ipad with the kevinmd logo

    3 concerns about the legalization of marijuana

    Jonathon Savage, DO

More in Conditions

  • How modern lifestyle changes are disrupting our immune systems

    Kara Wada, MD
  • Overcoming the lies of depression: Senator John Fetterman’s struggle with mental health

    Harvey Max Chochinov, MD, PhD
  • Proposed USPSTF guideline update: Advocating for earlier breast cancer screening at age 40

    Hoag Memorial Hospital Presbyterian
  • The rising threat of lung cancer in Asian American female nonsmokers

    Alice S. Y. Lee, MD
  • Urgent innovation needed to address growing mental health crisis among children and families

    Monika Roots, MD
  • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

    Cheryl Lazarus
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • How excessively regulating doctors can harm patients

      Richard Gunderman, MD, PhD and James Lynch, MD | Physician
    • AI-driven solutions for burnout, patient empathy, and worker shortage

      Harry Severance, MD | Tech
    • How modern lifestyle changes are disrupting our immune systems

      Kara Wada, MD | Conditions
    • Empathy and awareness: Unveiling the hidden dangers of food allergies [PODCAST]

      The Podcast by KevinMD | Podcast
    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 20 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Residents, Fellows at Mass General Brigham Vote to Unionize
  • Alzheimer's Drug Clears Major Hurdle Toward Full Approval
  • Did FDA Apply Rigorous Standards in Approving Paxlovid?
  • MitraClip Shines in Real-World, Core-Lab Data
  • Video of Stem Cell Injection Alarms Doctors

Meeting Coverage

  • MitraClip Shines in Real-World, Core-Lab Data
  • Risankizumab Safe in Older Crohn's Disease Patients
  • How to Better Identify HER2-Low Breast Cancer
  • Higher Fetal Cortisol Levels Linked to Sleep Onset Delays
  • Novel LAA Closure Device 'Promising'
  • Most Popular

  • Past Week

    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • Is chaos in health care leading us towards socialized medicine? How physician burnout is a catalyst.

      Howard Smith, MD | Physician
    • Georgia’s new law promoting truth and transparency in health care credentials

      Carmen Kavali, MD | Policy
    • Revealing America’s expansion: the dark truth of Native American suffering and unjustified abuses

      Anonymous | Physician
    • The rising threat of lung cancer in Asian American female nonsmokers

      Alice S. Y. Lee, MD | Conditions
    • The tragic story of Mr. G: a painful journey towards understanding suicide

      William Lynes, MD | Physician
  • Past 6 Months

    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • A physician’s typical day, as envisioned by a non-clinician health care MBA: a satire

      Jennifer Lycette, MD | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Proactive risk management: a game-changer in preventing physician burnout

      Howard Smith, MD | Physician
  • Recent Posts

    • How excessively regulating doctors can harm patients

      Richard Gunderman, MD, PhD and James Lynch, MD | Physician
    • AI-driven solutions for burnout, patient empathy, and worker shortage

      Harry Severance, MD | Tech
    • How modern lifestyle changes are disrupting our immune systems

      Kara Wada, MD | Conditions
    • Empathy and awareness: Unveiling the hidden dangers of food allergies [PODCAST]

      The Podcast by KevinMD | Podcast
    • The alarming epidemic of physician burnout and how we can combat it

      Tomi Mitchell, MD | Physician
    • A retired physician’s battle with moral injury

      Hayward Zwerling, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When patients abuse emergency department workers
20 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...