Violence is endemic in our hospitals. In the US, over half of all emergency room staff are threatened by people bearing weapons at least once in their working lives. It is widely reported in the nursing literature, however mentioned much less in the medical literature.
Violent thoughts and actions should be expected – they are usually short lived and can be managed.
The situation in general practice is no better. In Australia, verbal abuse is as common and the additional risk of property damage runs at nearly 20%. There is some evidence that violent acts are even higher beyond the industrialized nations. In Kuwait, Pakistan and Saudi Arabia, over two thirds of doctors experience verbal insults or imminent threats of violence and up to seven percent of these threats result in serious or fatal injury.
Explaining grave situations, poor prognoses, the need for costly surgeries or treatment and the unexpected consequences of the treatment are some of the top reasons why patients resort to violence with clinicians.
As clinicians, we are trained to communicate in a way that promotes a rational understanding of the uncertainty of medicine. However, it is difficult to control the responses of patients when lies or omissions are propagated in the name of improving health. For example, it is a lie that there will ever be enough money around in the system to ensure the optimal health of all. Even with the best of will, no economy – public nor private can fund health care to the levels that meet community expectations. Crumbling infrastructure cannot be explained away – even by the most skilled clinician. So, it should be no surprise that assaults are more frequent when a service is denied or delayed or patients encounter expensive financial outlays.
Protective measures such as panic buttons, secured doors, bullet or shatter proof barriers, secured furniture, safe rooms for staff and metal detectors are becoming more common in our health services. They are not long term solutions. They are just turning our hospitals into high security institutions. Efforts to lower tensions in hospitals such as improving the ambience of the environment with soothing wall colors and noise reduction are also bandages over festering wounds.
Healthcare settings are life and death places where emotions run high and there is a lot of short term uncertainty. Violent thoughts and actions should be expected – they are usually short lived and can be managed. Appropriate places for patients to express their anger in ways that do not harm others would be a good start.