Violence In A Health Care Setting Is Still Unacceptable

Most instances of violence against health care providers occur in relation to psychiatric patients and facilities.  Just because a patient is a psychiatric patient, doesn’t excuse the person or their behavior. But, take a step back and consider violence in the non-psychiatric patient population.

I was actually considering writing about an anecdotal experience at a facility I’m familiar with where a physician was performing a bedside procedure on a patient (he had gotten consent prior). The patient, as the story was told to me by an eyewitness, was an appropriate hospice candidate but he/she and family decided to pursue more aggressive treatment. Part of that treatment involved the need for the bedside procedure mentioned earlier. Once the procedure started, the patient had made comments that he/she was experiencing pain and wanted the doctor to stop. The doctor, wanting to finish since only a few minutes more would be required, desired to continue. As was recounted to me, the patient then promptly slapped the physician, who was of course shocked by this behavior. The doctor stopped what he was doing and informed the patient that no more procedures would be done and the patient should consider hospice.  The doctor then walked out of the room and did not return. I was going to title this particular blog “Slap Your Doctor, Go to Hospice”.

The idea of the whole incident was funny to me, and anyone who has heard the story, mostly because the physician involved can be an ass and likely deserved it. Granted, he should have stopped when asked. The physician’s behavior alone could represent assault on a patient. There are more than a few nurses who have felt the wrath of “Dr. Slap” sometime in the past and probably wanted to slap him too. That patient is their hero.

But researching the story made me run across several articles where health care providers were the recipients of violence committed against them by the patients they care for, sometimes with a loss of life. I actually ran across a blog post by KevinMD, the self-proclaimed social networks voice of medicine.  But not for me.

In his blog post he describes several issue of violence involving patients and health care workers. Most involve psychiatric patients, but not all. In one such instance a patient bludgeoned a nurse with the leg from a broken chair. Another involved the shooting of a physician by a patient’s son, distraught over the fact that her mother’s treatment didn’t go as he expected. After shooting the physician, the son went to his mother’s room at the hospital, shot her and then himself.

Stories abound in the Emergency Departments where intoxicated, drug dependent, frustrated patients become violent unexpectedly, striking the very people who are trying to help them. Nurses are an especially easy target since they often have more contact with patients. One quote rang in my ears; “…..and others said it is important to combat the notion among police, prosecutors, courts — and, at times, nurses themselves, who are often reluctant to press charges — that violence is just part of the job.” Violence should never be accepted as “part of the job”.

Some have cited a decrease in funding for mental health and substance abuse programs due to the economic downturn. Others look to the frustration people experience when they go to the ED in search of “McDonald’s” service in an already overburdened ED. Whatever the cause, the numbers of cases of violence are on the rise. So much so in fact that JCAHO (The Joint Commission on Accreditation of Hospital Organizations) released their own statement on the issue. State Workers Compensation department are also expressing interest since many claims for injury fall into their domain, increasing their Departments costs. Laws are finally being passed providing some legal remedy to health care workers who are the victims of assault. In New Mexico for example, it raised health care assault to a felony from a misdemeanor and provided an avenue to collect data on health care worker assaults.

OSHA published “Preventing Workplace Violence for Health Care & Social Service Workers” in 2004. In that publication, OSHA recommends a “zero tolerance” for violence, regardless of its cause. They also cited statistics showing the average rate of violence in the private sector workplace to be 2 per 10,000 full time workers, while nurses on the other hand suffer the most instances of assault leading to injury a whopping 25 per 10,000. The Bureau of Labor Statistics has data showing a similar risk of violence.

KevinMD, in his blog post recommended that “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,….” After reading the blog, I got the very distinct feeling he isn’t in the hospital very often and probably out of harms way. JCAHO believes more effort should be geared towards securing areas from violence including the use of metal detectors and inspecting bags. They also recommend the reporting of assaults and violence to law enforcement. Sorry KevinMD.

This may be the one time JCAHO and I agree.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.

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3 Responses to “Violence In A Health Care Setting Is Still Unacceptable”

  1. Agreed. While the story at the beginning was funny, especially if the guy was an asshole, getting pimp slapped by an old lady is much different than being shot at. Perhaps the real issue here is tag team of entitlement and positive expectations. Every patient who walks into a hospital with a true medical need should be treated in the most efficient manner possible and given the care they need. Yet, this should not mean that your broken finger men’s the same thing to an ER Dept as a gunshot wound. But some still find the balls to bitch if they see someone go ahead of them, not because that person may be the sickest of the two, but because its not “fair”. Likewise, I think that most people hold the positive expectation that they/their loved one who goes into the hospital will walk out regardless of the circumstance. Sadly, this is not the case all the time. Some things simply cannot be fixed. As has happened to me personally, anger and confusion in these scenarios create a situation in which you are no longer being rational. My behavior took the form of studying the deceased’s death certificate and trying to find a link between her problem and the treatment which while necessary, may have exasperated her death. Was this the case? I don’t know. I was just sad my grandmother has died and I wanted to blame someone. I was angry. But at no time did I want to shoot, stab, burn, kick or punch the doctors or nurses that took care of her. They were all classy, smart and dedicated individuals that take care of cancer patients daily. Daily. So, dear patrons of the ER’s around the country before you throw a hissy that you waited four hours to be seen by a doc because your belly hurts, realize that while you watches tv and drank a pop in the waiting room, Doc So and So may have been trying to save someones life or close a gaping head wound. Or perhaps he just lost a patient despite his best efforts. Try and sympathize with seeing the things they see, daily, and the problems they must solve. Hopefully, this will help you realize the smallness of your plight and root for the only real “gods” you will ever encounter. The ones who can fix you and maybe be there to save your life.

    ” The problem with the hospital isn’t the disease, newbie. It’s the patients. How do we explain to them that we are in a war every single time a new admission steps through that door against an enemy that is relentless? All we can hope for in this place is to delay what will eventually happen anyway. Death doesn’t care what we do to save a patient, because at the end of the day, he wins. But no one wants to hear that, do they? Everyone wants a dose of the feel goods….” Dr. Cox, Scrubs.

  2. I don’t think the frustration everyone feels will get better anytime soon. Rationing will only make the situation worse. A major concern is what could happen to the front line caregivers (nurses, etc.) who bear the brunt of the assaults and violence. What if the number of people choosing nursing as a profession plummets because it is the most dangerous job in health care?

  3. Hello there! This post could not be written any better! Reading through this post reminds me of my previous room mate! He always kept chatting about this. I will forward this page to him. Fairly certain he will have a good read. Many thanks for sharing!

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