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Join Harry Severance, an emergency physician, as we explore the factors contributing to this issue, including the impact of the COVID-19 pandemic and the demonization of health care workers. Discover the alarming statistics and consequences presented by organizations like the Association of American Medical Colleges and National Nurses United. Harry shares his perspectives on the mass exodus of health care professionals, the instability of hospitals, and the challenges faced in providing critical care. Gain valuable insights into the need for action and the role of public awareness in addressing this pressing problem.

Harry Severance is an emergency physician.

He discusses his KevinMD article, “The escalating violence in health care workplaces: a critical problem facing the nation’s health care system.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Get CME for this episode by clicking on the CME link in the show notes. Today we welcome Harry Severance. He’s an emergency physician. His KevinMD article is titled “The escalating violence in health care workplaces: a critical problem facing the nation’s health care system.” Harry, welcome to the show.

Harry Severance: Glad to be here.

Kevin Pho: So we’ll get into your article in a little bit. First off, briefly share your story and journey to where you are today.

Harry Severance: As you noted, I’m an emergency physician, residency-trained. I’ve been doing this since I completed residency training in 1986. Actually, I was asked by my institution to complete an additional year, and I simultaneously completed training in emergency medicine and internal medicine, the first one at that institution to do so. Since then, like I said, I’ve been an emergency physician in a variety of venues, most of the time in academic-type emergency centers with residency training programs.

But more recently, I’ve migrated into an interest in all of the sequelae and disturbances that are going on in health care workplaces, not just emergency medicine but across the hospital as a whole. I have been doing some presenting and writing on that, which has caused me to come to the attention of various people who have reached out to me and said, “You know, I heard your lecture. Can you please help me? I don’t think I can do this job anymore. Can you give me some guidance?” So I’ve kind of migrated into that as a service that I provide. And through our medical societies, that’s what caused me to be in Congress the first week in May, talking to many of the staffs of some of our congressmen and senators about this issue of violence in the workplace.

Kevin Pho: So let’s jump right into that here. Your KevinMD article is titled “The escalating violence in health care workplaces: a critical problem facing the nation’s health care system.” Now, give us some context. Tell us how your article came about.

Harry Severance: Well, again, I was asked by our state medical society and by our society, the Tennessee College of Emergency Physicians, to be prepared to present this during our week on Capitol Hill to some of the staffs. As you are probably aware, periodically groups of physicians, nurses, and other health care workers will go through the offices of the congressmen and senators and talk to their staffs about issues that we feel they need to hear more about. Since this is a topic that had already been of interest, they asked me to go gather data and be prepared to give them some fairly succinct but very hard bullet points on the numbers that we’re seeing. That’s how this came together.

To jump ahead a little bit, what caused me to write the article was that when I presented to Congress, they seemed to be sort of aware of this, but I have to say that in many cases I sensed this was not a burning issue with them. That was on the first Tuesday in May. Then, if you remember, the next day, on Wednesday, there was that fatal shooting in a clinic in downtown Atlanta. That kind of caused me to say, “I’m going to take this data and see if I can submit it and get it published.” That’s how the article came to be.

Kevin Pho: So tell us about the situation as it relates to health care workplace violence. What are some numbers? How bad is the situation?

Harry Severance: The biggest number, the biggest bullet point that I found, and the information is out there, anybody can look for it, is this: We have the Association of American Medical Colleges, we have our own federal government, and we have a bunch of private companies that look at this data, and all of them are saying exactly the same thing. The numbers show that, unquestionably, secondary to assaults and violence, the health care workplace is the most unsafe workplace of any, bar none, in this whole country. It’s more unsafe than the police department. It’s more unsafe than the military. It’s more unsafe than heavy industry.

The other thing they’re going to point out is that we’re not seeing all the numbers. Hospitals tend to be very reticent about talking about violence in their workplace. They believe it’s discouraging: You don’t want to walk into an office where you think somebody might beat you up. So many times they don’t want this data out there.

So what we’re seeing is the tip of an iceberg. We’re seeing the assaults with deadly weapons, those attacks that by law are required to be reported, and many authorities say we’re only seeing the tip of the iceberg. But even with that, by the numbers, 75 percent of all recorded workplace assaults occur in health care. If you’re a health care worker, you have over a 50 percent chance of being physically assaulted sometime in your career. That means hit with a fist, hit with an object, stabbed, or shot. You might die just because you showed up for work. Those are the compelling numbers.

Kevin Pho: So tell us some stories that you’ve heard during your research that really bring those numbers to life and make those numbers resonate.

Harry Severance: As I said, I get some of this from my individual interactions with people calling me and saying, “You know, I just don’t think I can do this anymore. What are my options?” I’ve not had anybody yet tell me that they themselves have been stabbed or shot. I’ve had several people tell me they’ve been pushed or kicked, various types of what I would guess, next to gunshots and stabbings, you’d call minor assault. That may not be right, but anyway. Like I said, I’ve not had people tell me that they’ve been stabbed or shot, but I’ve had a couple tell me that the reason they called is that one of their colleagues witnessed a major assault down the hall, ran toward it, and got involved.

But what I have heard over the past year, for the first time, is people reaching out to me saying, “You know, I’d like to explore alternatives.” What I try to do first is drill down and ask, “What are the root causes of your dissatisfaction?” And like I said, over the past year, for the first time, I’m hearing from the people calling in that their families, their spouses, their parents, maybe their children, some loved ones, or close friends are now asking them, “Can’t you please get another job, a job that’s safer?” That has started to resonate with me. People, or their families, are now recognizing, “We’re afraid for you to go to work.” And that’s a sad state.

Kevin Pho: And this is across the health care spectrum, right? It’s not just the physicians.

Harry Severance: No, this is physicians and nurses. In the numbers, nurses are assaulted more frequently than physicians. They’re more readily available, and they may spend more time with the patients and the families. They suffer the majority of the assaults.

Kevin Pho: Now, during your research and hearing these stories, what do you think are the reasons behind the increased number of health care assaults?

Harry Severance: It’s multifactorial. Patients are more dissatisfied. During the COVID pandemic, there was this politicization, and that’s multifactorial, but on social media, physicians and sometimes nurses were demonized for various reasons: “We have an agenda. We want a certain medication. You’re refusing that medication.” And somehow it became all right, and maybe this exploded during COVID, but somehow it became all right to physically assault people if you’re not getting what you want. So that was one crux of it.

Health care is becoming more and more difficult to navigate. I mean, patients are frustrated. They have a medical problem, and nobody seems able to answer how to fix what’s wrong or can even direct them as to where to go next, with the whole house of medicine becoming more and more fractionated. And like I said, there’s a lot of frustration among patients, involving distrust of physicians, other health care providers, and the institutions themselves. Sometimes this comes out as, you know, people having a bad moment and going physical. I think that’s probably one of the biggest cruxes of this.

Kevin Pho: One of the things that you mentioned earlier was that hospitals were reticent to talk about these numbers and publicize these health care assaults. I’d like you to talk more about that. What exactly have you seen and heard regarding that?

Harry Severance: Again, I’m not seeing that at the hospital where I work right now. As an aside, I’ll tell you, based on the stories that people tell me about their work situations, I go to work thankful every day. You know, every hospital has some problems, but I’m sitting there going, “I’m not seeing anything near the stories that I’m hearing from the people who reach out to me.” So again, I can’t give you any hands-on personal experience with that. But I’m being told, both by the people who talk to me and by agencies that I talk to, and I’ve read many articles that support this, that for a variety of reasons, hospitals would prefer that episodes like this, violence occurring in the halls of their hospital, not be reported. The main reason is that they see that as discouraging patients. So that is my understanding of the main reason they would simply prefer this not to be reported.

As I said, I’ve not talked to anybody yet who has been shot or stabbed themselves, but I have talked to people who have been pushed around, maybe knocked down, maybe kicked. Several of them have told me that someone in the hospital, a senior administrator, sat down with them and, either subtly or in a couple of cases maybe blatantly, said, “Can we keep this quiet? This is not good for the reputation of the hospital. What do we need to do to make this go away?” So they’ve told me that themselves. I’ve had maybe two or three people tell me that that was their interaction with the hospital afterward.

Kevin Pho: We’re talking to Harry Severance. He’s an emergency physician. His KevinMD article is titled “The escalating violence in health care workplaces: a critical problem facing the nation’s health care system.” Harry, tell us the path forward. What are some potential solutions to stem the frequency of health care workplace violence?

Harry Severance: Again, the answer is multifactorial. I think hospitals have to recognize and accept the fact that these events are occurring and start to do things to try to prevent this. You know, for many hospitals there’s the expense, and kind of almost a discouragement, of things like metal detectors at the doors of the hospital and things of that type. Again, hospitals see this as a discouragement. None of us enjoy going through TSA on the way to get on the plane, but we see it as just a necessary thing that has to be done. I think hospitals have to step up and protect their staffs.

I would also like to see something else. One thing I learned when I was in the halls of Congress, and I mentioned a little bit earlier that I got the sense this was not a burning issue, was this. I’m thinking, “These numbers are some of the worst I’ve ever seen. Why isn’t this on your plate?” Because there are bills in front of Congress on various laws about workplace violence, and they’ve been stalled for the past two or three years. But what I’m hearing, subtly, from the staffs of these senators and congressmen is that they don’t get a lot of calls, letters, or communications from the public as a whole saying something needs to be done about this. And as we know, one thing that drives our government, our Congress, is constituents. Senators and representatives keep numbers. If they get something saying 90 percent of their constituents want them to vote this way, they pretty much do that. But what they’re telling me is that not a whole lot of citizens are calling in and seeing this as a problem.

And I suspect, one, that we don’t see it. Like I said, only the major ones, the gunshot wounds and the stab wounds, ever make it into the news. I think in my article I pointed out airplanes. People have their little phones up there, and any assault on an airplane makes it to the news, maybe before the plane lands. So in many cases, the public’s not aware. Part of that is HIPAA rules; you’re not allowed to film patient interactions. But the other thing, I think, is that health care is something that people don’t want to have to think about. Being sick is not something you want for yourself. So health care is that thing where I want to know, somewhere in the back of my mind, that health care is guaranteed. I want to know that, God forbid, if I’m really sick, somebody will take care of me and I’ll get the best care I can get. But I don’t really want to talk about it. I don’t want to think about it. And I think the public, in my own opinion, kind of shies away from this information until and unless they become a patient themselves or have a friend or colleague who suffers violence.

The congressional staffs tell me that the people they hear from on these issues are the people you would expect: doctors, nurses, and patients who have suffered harm. But they’re not hearing a groundswell. They’re not getting “80 percent of our constituents want you to do something about violence in the workplace.” So again, as I said, it’s not the number one burning issue on their plate, and that’s why I think these bills are stalled in Congress.

Kevin Pho: And my final question, Harry: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Harry Severance: I would encourage people in general to look at these numbers, that 75 percent of all assaults occur in the health care workplace, and to reach out and talk to people. Talk to the hospital. Talk to your congressman. Say, “You know, this needs to be fixed.” Why would I ask the general public to do this, other than just protecting our health care providers? This is causing a further reduction in doctors and nurses in our health care workplace. As I pointed out in the article, four to five million health care workers have left health care in the past two years. I myself, as I told you earlier, am getting calls and interactions from people saying, “My spouse wants me to get a safer job.” So people are exiting health care. Doctors and nurses are leaving because of their fear of showing up to work and not coming home alive.

That’s causing hospitals to shut down. We have 630-some hospitals in this nation right now that are at risk. They didn’t pass their stress test, and they are at extreme risk of closing, mainly in rural areas, but that is expanding. So if we can’t solve the violence crisis in the health care workplace, that is going to further deny access to all patients. You know, God forbid you need to go to the emergency department of the hospital with a critical problem, but if and when you do, you want to know it’s there and can serve you. And if we can’t address this issue, in your hour of need that hospital may no longer be there.

Kevin Pho: Harry, thank you so much for sharing your time and insight, and thanks again for being on the show.

Harry Severance: You’re welcome. Glad to be of help.