Majority of Clinicians Experience Verbal Abuse, Intimidation

Alicia Ault

September 29, 2017

The workplace appears to be an occasionally toxic environment for healthcare providers, as a majority of those responding to a recent Medscape Medical News poll said they had been victims of a range of verbal and physical violence at the hands of patients, and, often, colleagues.

Another large majority said they had witnessed violence, and most respondents said they had been given only minimal training to respond to the onslaught, and that there were insufficient protocols in place to protect them.

The poll was conducted in late July, in the wake of the shooting death of Tracy Sin-Yee Tam, DO, a 32-year-old family physician at the Bronx-Lebanon Hospital Center in New York City. A disgruntled ex-employee — a physician — murdered Dr Tam and wounded a patient, two medical students, two residents, and a gastroenterology fellow, before killing himself.

Overall, 88% of the 2389 respondents to the poll — who included nurses, advanced practice nurses, physicians, pharmacists, and other providers — said they'd personally experienced verbal abuse, and 76% said they'd experienced intimidation. About two-fifths said they'd been victims of physical assault, and 30% had experienced sexual harassment. Respondents also reported having been stalked.

Ninety-two percent said they'd witnessed verbal abuse and 81% said they'd witnessed intimidation, while 55% said they'd seen a physical assault.

Most often, the perpetrator acted out because of altered mental state from a mental illness or substance abuse, said poll respondents. Sorina Simion-Rodgers, MD, a psychiatrist, said, "The assaults (both physical and verbal) as well as intimidation and threats that I experienced were not from severely ill mental patients or dementia patients, but rather from malingerers, personality disorders, substance abusers and families."  She added, "We are told by administration that being abused, hurt or even disabled by an attack is 'part of our job.'"

Susan Hicks, a pharmacist, said that "a patient who demanded a controlled drug" tried to harm her with a box cutter, but, "luckily, I was able to move fast enough to get away from the patient." Hicks said she "also experienced verbal abuse from drug seekers and pseudoephedrine seekers."

Some commenters said they had experienced or witnessed violence from patients — or families — who were just plain unhappy with the response they got from health providers. Overall, for instance, 38% said people were irked at long wait times, and 26% said the acting out was in response to receiving bad news.

"Some patients and/or their families become verbally abusive when they don't agree with your diagnostic impressions and/or treatment plans, leading to a difficult situation," said Emilio Gonzalez, MD, a rheumatologist.   

Seventeen percent said what they witnessed or experienced was a reaction to overcrowding, and a quarter said it was from a disgruntled employee. Overall, 29% of respondents cited "other" as the reason for the violence, which some commenters suggested was a stand-in category for employee-on-employee violence.

"I had to meet with the chief of police regarding threats of physical violence made against me by faculty in my own institution," said Edward Klatt, MD, a pathologist. The administration "did nothing," said Dr Klatt, adding, "Incivility sucks the life out of an institution. Everyone is adversely affected in some way."

Nursing, Emergency Medicine Most Under Fire

Nurses and advanced practice nurses reported personally experiencing or witnessing physical assault more than physicians, pharmacists, or other healthcare providers. Half of all nurses said they were victims of an assault compared with 36% of physicians, 18% of pharmacists, and 24% of other providers. Nurses in emergency medicine settings reported the highest rates of assault — 77% said they'd experienced physical violence — followed closely by those in psychiatric settings.

Verbal abuse and intimidation of nurses was also higher in emergency medicine than in family medicine. Nurses in emergency medicine, psychiatry, and family medicine also reported much higher rates of sexual harassment — both experiencing it and witnessing it — than physician colleagues. Some 42% of psychiatrists, however, said they'd experienced sexual harassment — compared with 28% of emergency medicine doctors, for instance.

Emergency physicians and psychiatrists also experienced and witnessed more physical assault than colleagues in family medicine (25%) or internal medicine (29%). Some 68% of emergency physicians said they'd experienced an assault, and 99% said they'd witnessed violence.

Psychiatrists were more likely to report they'd been victims of stalking — 23%, compared with 13% of emergency medicine doctors and 9% of internists.

Sadly — but perhaps not surprisingly — the violence seems kept under wraps by victims.

About a third of psychiatrists and psychiatry nurses said they always reported violence they had experienced, but they seem to be the exception. Overall, only 18% of emergency nurses and 11% of emergency physicians said they always reported being victims of violence. Nearly 60% of emergency room nurses sometimes, rarely, or never filed a report.

Hospitals Cited as Unsupportive

Overall, the hospital was reported most often as the environment where violence was experienced or witnessed, cited by 85% of respondents. Physicians also reported violence in office and outpatient settings.

Almost 70% of the total respondents said they'd received no or minimal training in how to cope with workplace violence. Many commenters said they blamed administrators for not taking workplace violence — and bullying — seriously.

"I was violently physical[ly] assaulted in an outpatient mental health facility on March 16, 1998," said Debra Riggs, RN, who added, "I have had severe and chronic [post-traumatic stress disorder] since that time." Riggs said the facility's CEO contacted her after her treatment, and that "he thought it funny that my colleagues wanted security in the workplace." The nurse said that friends and coworkers ostracized her and that she received no support from colleagues or administrators.

Another RN, Denise Bleak, said she had experienced bullying. "I've been kicked in the chest, slugged in the mouth, hit on the head by an administrator (she stopped when I told her she was on camera), had a doctor throw a chart at me as a new RN in ICU."  

"My message to all is always speak up, report, and learn to say loudly if it is a coworker, 'stop it. I don't like that.' Being loud made me unpopular and kept me safe."

Bleak said she believed that "there is no administrative safety culture (it is often fakery) and little peer support for square pegs in round holes."

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