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Physician Abuse: The Dark Side of Medicine

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"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."

Carl Bell, MD, a psychiatrist and vice chairman of the American Psychiatric Association's task force on violence, tells WebMD that Mackin's findings are somewhat unexpected and will serve a useful purpose in "laying it on the table" to alert other pediatricians. Bell also encourages physicians to be more active in determining which patients may be a threat and to warn them in advance that any inappropriate behavior will not be tolerated.

But patients and relatives of patients must do their part and not sit silent, growing ever more angry, if they are having a conflict with the physician, says Bell.

"I think communication is the key. It is a relationship issue. If the doctor is not providing good leadership, the patient needs to provide good leadership. The doctor works for you, and you can always fire [him or her] and get another one," he says.

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