There were 54,758 physical assaults reported by NHS staff in 2008-9, including 3,472 in primary care, according to the latest statistics from the NHS security management service.1 Happily, this represents a decrease of 1,235 reported assaults compared with the figure for 2007-8, but that may be little comfort if you are unlucky enough to become one of the statistics.
Of 172 GPs and hospital doctors who responded to a recent MDU survey3, 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.
...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
Examples of incidents in the MDU survey included 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.
Of the doctors who were assaulted, around a quarter (24) suffered anxiety or depression after the event and four doctors needed medical treatment, for injuries such as cuts or lacerations.
Flashpoints
Thankfully, only a small minority of patients are physically or verbally abusive or demanding to the point of aggression and being ill can itself sometimes be the cause. Other flashpoints can include excessive waiting times and delayed appointments. Patients may feel that their concerns are not being taken seriously, be disappointed at the lack of therapeutic success or feel guilty at not having brought a sick relative in earlier.
Thankfully, only a small minority of patients are physically or verbally abusive or demanding to the point of aggression and being ill can itself sometimes be the cause
Whatever the reason for a patient to become aggressive or abusive, such incidents rarely come out of the blue. The patient may have a previous history of violence, or have drug/alcohol problems or you may be able to tell that a situation is escalating out of control. Ideally, the PCT or Trust will have arrangements in place so that a violent patient can be seen at a suitable, safe location.
Defusing a violent situation
Recognising the warning signs may prevent many situations from escalating. But dealing with a potentially violent patient takes care, judgement and self-control.
If you believe your patient is showing signs of becoming angry or aggressive it may be safer to leave the room immediately and seek help from a colleague or call the police/ security guards.
But dealing with a potentially violent patient takes care, judgement and self-control
In less extreme situations, you may be able to prevent the patient’s anger from escalating by considering taking the following steps:
- Listen to what they are saying, ask open-ended questions and remain calm
- Reassure and acknowledge grievances
- Maintain eye contact, but don’t prolong it
- Maintain an adequate distance from the patient, but keep away from corners
- Ask for weapons to be put down (not handed over)
- Use the panic button/call for help
- Leave the room and seek help from security or the police
- If possible, remove the patient to an area away from public view.
You might also want to think about arranging training for you and your team in anticipating and responding to such situations. Your local police station may also be able to advise you on safety strategies and the security of your work premises. The MDU offers training to members in communication skills and a seminar on dealing with difficult patients.3
© copyright MDU 2010
References
- NHS security management service press release, 16 November 2009.
- 172 doctor members responded to the MDU’s web based survey (94 GPs/GPSTs and 78 junior, non-consultant and consultant hospital doctors) in a three week period during November 2009. This represented a 4% response rate.
- For more information on the MDU’s communication skills course see www.the-mdu.com/education. For the MDU’s seminars on dealing with difficult patients, members can contact their local hospital or GP liaison manager via www.the-mdu.com