Public Servant Lifestyle

More than one in three doctors who took part in the UK-wide survey experienced some form of violence over the last year. Half of all British doctors believe violence is a problem in their workplaces, according to the new report from the British Medical Association (BMA), entitled Violence At Work: The Experience of UK Doctors

Almost 1,000 doctors responded to a BMA postal survey asking about workplace violence, the key findings were as follows:

Violence is a problem in the workplace for almost half of doctors

One in three respondents had experienced some form of violence in the workplace last year – this was the case for both hospital doctors and GPs

Amongst hospital doctors those working in Accident & Emergency (A&E) and psychiatry units were more likely to experience patient violence

Amongst doctors who reported some experience of violence, almost all (95%) had been the victim of verbal abuse in the past year

The main causes of violence were perceived to be health related/personal problems, dissatisfaction with service provided, drugs and/or alcohol

Seven out of ten doctors surveyed had not received any training on how to deal with violence despite the fact that medical sites in the UK have been found to have the greatest risk of all workplaces for verbal and physical threats to staff.

Threatening Behaviour

Dr John Garner, Chairman of BMA Scottish Council said: "Threatening behaviour towards NHS staff by patients and their relatives is becoming a common problem for staff in all areas of the health service and some even consider violence to be an occupational hazard. It is unacceptable that health care professionals should be living with the fear of violence or that the threat of violence be an acceptable part of their job. It is no wonder we struggle to recruit and retain staff and unless there is a cultural change in behaviour, this will go from bad to worse.

"A clear message needs to be sent out by the Scottish Executive that violence will not be tolerated. Attacks should be treated with the full force of the law, as is currently the case for assaults on police. Increased security, enforced sanctions against violent patients and taking legal action where appropriate are some preventative measures which would reduce the incidence of violence against healthcare staff. Doctors should be able to care for patients without fearing for their own safety."

Mr James Johnson, BMA Chairman, said: "No-one working in a hospital or GP practice should have to put up with the threat of physical or verbal abuse. We're talking about people who go to work in order to try to alleviate pain and treat ill-health – the fact that they may expect to be punched, kicked or shouted at cannot be tolerated."

The BMA is calling for health care facilities to be designed with the prevention of violence in mind and a greater emphasis on regular and ongoing training for staff to deal with and diffuse potentially violent situations.

The organisation is now making a number of recommendations to tackle the problem of violence towards doctors:

Training should be in place for all healthcare staff to handle potentially violent situations – this could include methods of restraint, communication, managing aggression and personal safety

Doctors and other healthcare staff should be working in partnership with local police, the relevant agencies and the media to tackle violence

Patients must be made aware of their responsibilities and acceptable behaviour – they need to know that violence will not be tolerated

It should be compulsory for violent incidents to be recorded. De-briefing or counselling facilities should be offered

Substantial differences in the perception of workplace violence exist amongst hospital doctors according to speciality. For example, nine out of ten A&E doctors and seven out of ten doctors working in psychiatry reported violence as a problem in their workplace, which compares with only around 20% of doctors working in geriatrics.

A quarter of doctors who responded to the survey believed there had been an increase in workplace violence in the past year. This is particularly the case for GPs.

Extracts from the BMA report Violence at work: the experience of UK doctors:

"During a consultation a patient suddenly jumped up and locked the surgery door. He stated that he was going to kill me. His manner led me to believe that the threat was genuine. The panic button was difficult to reach and failed to work. The incident lasted around 25 minutes before I could obtain help. The phone lines to reception/practice manager were all engaged. Police arrested him from the surgery."

"A patient came in and was very agitated; he was brought in for a minor physical check but had a drug related psychosis and had also assaulted a member of his family. No one had warned us before the consultation. He simply ran to punch me but was held back by someone else who he then hit."

"Child protection cases have provoked verbal abuse when attempting to assess the child. Drunk(en) parents can be hostile, obstructive and verbally abusive. I have also experienced suggestive remarks and inappropriate touching. One man pushed me against (a) stair wall in our clinic."

Aggressive, Hostile

"I have never been physically assaulted, but have been sworn and shouted at. Usually because patients felt that they had been waiting too long to be seen, or they wanted a different treatment or that treatment sooner."

"I was at the receiving end of some aggressive and hostile behaviour from patient's spouse, as a response to a request for some information about patient's history. Eventually this got so bad that I could not continue the examination."

"I was on call during a night shift in A&E. I went to see the first patient who had been waiting for four hours to see a doctor. The husband of the patient shouted at me for keeping them waiting, he was extremely rude and aggressive even when I explained how the shift system worked and that I was sorry they had been waiting so long."

"A patient's mother once hit me on the face with a mobile phone."

"I've been on the receiving end of intimidating and abusive comments and behaviour especially relating to perceived poor practice (e.g. unable to cure cancer etc)."

"The following patients attacked me, one who wanted a letter on the spot for DSS which GPs do not provide, another who wanted a painkiller tablet for hay fever, and another who was turned down by an insurance company and he felt that was my fault. I can go on..."

"There is no single incident but patients or relatives get abusive if they cannot get what they want, when they want it."

"Typically a patient waits 3-4 hours with a trivial complaint that should have gone to GP, then gets angry with A&E staff because we don't 'cure' them."

Verbal Abuse

"Verbal abuse is a common occurrence at my workplace. This is not surprising, as the hospital is an acute psychiatric unit in a very deprived area."

"When I was a junior doctor a patient threatened me with a sharp weapon. The police were called and the man was arrested. The patient threatened to find out where I lived and ‘do me over’."

"When people are frustrated after waiting for a service, or the service does not meet their expectation, it is only human nature to be angry. Add to this a few pints of intoxicating liquid and what else do you expect?"

"Two youths intoxicated with alcohol demanded ‘Viagra’, on refusal to prescribe they verbally abused me shouting racist, sexist remarks, which were intimidating and humiliating to me."

"A patient became aggressive, as they only wanted to see a consultant and said the rest of us were useless."

"The patient threatened to find out where I lived and do me over."

"I have never been physically assaulted, but have been sworn and shouted at."

"It is frustrating that we get treated this way when a) we are trying to help and b) we are doing our jobs and c) little is done to prevent it or follow –up"

Staff Support

In Scotland, the Criminal Justice Bill currently protects emergency workers, but the BMA is calling on the Scottish Executive to extend this to cover all health care and public workers and to improve support for staff reporting incidents.

The report also highlights difficulties inherent in adopting a zero tolerance policy – the NHS in England having adopted such a policy to reinforce the message that violence against health service staff will not be tolerated. Doctors, underlines the report, are obliged to treat all patients no matter what their condition, and some incidents of violence can be brought on because of a medical condition. This approach, the BMA claims, can only work if it is backed by the resources and manpower to give staff the support they need.

Underreporting of violent incidents remains a widespread problem and the survey shows that there is lack of support and help for doctors who have experienced violence at work. No action was taken for a third of violence cases reported in the BMA survey.

"A Climate Of Fear"

Dr Jason Long, Chairman of the BMA's Scottish Junior Doctors' Committee said: "Many staff work in a climate of fear in hospitals. Although the majority of patients and relatives behave in the appropriate manner, a small minority are abusive to staff. Alcohol and drugs are not an excuse for this behaviour and we need better protection for all staff and better deterrents to stop this happening."

Dr Mary Church, joint Chairman of the BMA's General Practitioners Committee said: "With the new GP contract in addition to funding previously provided by health boards, services for violent patients will be funded as a Directed Enhanced Scheme. Not all practices will be obliged to provide services to known violent patients and secure facilities will have to be provided by the Health Board, for example in a local police station or a designated GP practice. However, this would not protect practice staff from patients with the potential but no history of violence.

"It has been seven years since a GP was murdered in his surgery and since then progress has been slow, funding has not been forthcoming and the education of the public has been minimal. We need to remember that it is not just health service staff who have been threatened by violent behaviour but also patients in waiting rooms."

Click here to read the full BMA survey

More information available in Work Environment, Advice, Professional Groups