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Physician Abuse: The Dark Side of Medicine

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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.

"In retrospect the warning signs in my own case were clear. Verbal abuse had become routine and was being ignored. The spirit of cooperation that usually exists between medical (and nursing) staff and [the family] had broken down and it had become increasingly difficult to manage the patient," he writes.

Ashton's story rings true for Arthur Z. Berg, MD, assistant professor of psychiatry at Harvard University.

"In almost every incident that I have heard about there is the usual story -- 'it seemed to come out of the blue' -- and when it is investigated further, it has never come out of the blue. It shows the power of denial," says Berg, who teaches threat management to healthcare workers and law enforcement officers.

Berg, who served on a violence task force impaneled by the American Psychiatric Association, also decries the lack of attention paid by U.S. medical schools and institutions to the problem of violence against physicians, a problem he says is more widespread than suspected. Attacks against physicians who provide abortions "make news," he says, yet they reflect a tiny percentage of the abuse suffered by all physicians at the hands of patients or their relatives.

"The other big problem is there are no good statistics," he says. "The numbers get buried with the doctors."

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