Physician Abuse: The Dark Side of Medicine
Jan. 25, 2001 -- When two physicians were attacked in an episode of the television show ER last year, it was a case of art imitating life. In fact, at least one physician is killed each year, and healthcare workers are among the top four victims of workplace crime, after taxicab drivers, convenience store clerks, and police officers.
Even pediatricians, who care for infants and children, are not immune to violence. A new study conducted in Ireland shows that 90% of a small sample of physicians who were in training to be pediatricians had been exposed to violence, most often in the form of verbal threats from parents and relatives of patients. Unfortunately, U.S. experts on physician violence say the situation is just as bad here.
The study, in February's Archives of Disease in Childhood, is based on a telephone survey of 75 pediatric residents conducted by Gerald Mackin, a pediatrician with the Foyle Community HHS Trust in Derry, Northern Ireland. The survey was taken, Mackin says, because he could find nothing in the literature that documented the frequency of violence against pediatricians. He found a high rate of it in his research, however, and he also learned that few physicians reported their encounters or were counseled on how to deal with them afterward.
Survey participants had been practicing pediatrics for an average of about 6 years, and about half were women. More than 90% reported experiencing "a violent episode of one kind or another," with 65% saying such incidents had occurred within the past year.
The most common occurrence was a verbal threat, but nearly half said they had received a death threat. Almost 11% said they were the victims of threatened assaults by relatives of patients, and 5% said they actually had been assaulted. Statistically, there were no differences between the levels of abuse suffered by male and female physicians.
Only 9 of the 68 doctors who had experienced violence had formally reported the incident, but more than 60% of them reported subsequently "worrying about the episode." Only one physician was offered counseling after the incident, and just 7 reported having any training on how to manage violent or aggressive patients or relatives.
Hospitals must do a better job of preparing physicians to face such situations, according to Mackin. This should include what causes aggression, how to prevent it, ways of dealing with violent people, and help on how to report incidents, he says.
Pediatrician Mark Ashton, himself a victim of an assault while at the hospital bedside of a patient, agrees.
Writing in an editorial, Ashton, who works at St Mary's Hospital in Portsmouth, England, laments that he did not take action to prevent the attack by three assailants. He and another physician were injured after a man and two women fought with them because they thought their 12-year-old severely disabled nephew was being given medication to hasten his death. They were sentenced to 9 months in jail.