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Doctors need more protection from violence

Many doctors face knives, verbal abuse, threats and scalding with hot drinks

OnMedica staff

Tuesday, 16 February 2010

Over 50% of doctors say they have been physically or verbally assaulted during the last five years according to a new survey. Examples include a consultant whose patient brandished a knife during a consultation, a doctor who had a hot drink thrown at her and a GP who was verbally abused and spat at. NHS figures reveal there were 54,758 physical assaults reported by NHS staff in 2008-9, including 3,472 in primary care.

Of 172 GPs and hospital doctors who responded to the survey by the doctors indemnity organisation the Medical Defence Union ( MDU), over half (99) said they had been physically or verbally assaulted in the last five years.

While some of the respondents accepted this as "part of the job", over half (100) said they had not received training in dealing with such situations and would like to feel more confident.
Of the doctors who reported attacks 24 suffered anxiety or depression after the event and four needed medical treatment for injuries such as cuts or lacerations. In around a quarter of cases, police or security guards were called.

The vast majority of respondents (139) said they had encountered a patient making unreasonable demands, such as insisting on a referral or prescription which they felt was not clinically indicated.

In seven primary care cases, violent or abusive patients were removed from a GP’s list. In six cases, the patient’s care was transferred to another doctor. Other strategies employed included patients being sent warning letters, banned from seeing certain doctors, or only being seen if accompanied by another health care professional.

In order to minimise the potential for problems the MDU advises doctors to consider identifying potential assailants or groups, such as patients with a history of previous violence, mental health difficulties or alcohol/drug abuse.

It also advises doctors to anticipate activities that might present a high risk of aggression – such as refusing an appointment or delivering bad news or unwelcome information.

And it suggests a look at the layout of your consulting room or reception. Can you exit easily if needs be, do you have panic alarms or CCTV?

  • Arranging training for yourself and your team in handling verbally or physically aggressive people.
  • Ensuring people know where you are, how you can be contacted and when you are expected to return when undertaking home visits in primary care.
  • Taking special precautions with any patient who has a history of violence such as trying to avoid seeing them alone or at their home. Ideally, the PCT or Trust will have arrangements in place so the patient can be seen at a suitable, safe location. If this is not possible, try to arrange to be accompanied by a colleague and make sure that your whereabouts is known if you visit them at home.
  • Disclosing only the minimum information necessary for the purpose, if it becomes necessary to disclose confidential information about a violent patient to a third party, such as the police, in the public interest.

Dr James Armstrong, an MDU medico-legal adviser, said the survey highlighted the need for more training for doctors in communication skills.  He added: "There can be many reasons why a patient becomes violent or aggressive. Being ill can itself be the cause. Excessive waiting times and delayed appointments can turn frustration to anger and lead to violent outbursts. Distress, feeling that their concerns are not being taken seriously, disappointment at the lack of therapeutic success or guilt at not having brought a sick relative in earlier may also be factors in a person becoming aggressive."

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