Patient Violence Against Physicians: What You Can Do

Leigh Page

Disclosures

April 30, 2019

In This Article

Violence Against Physicians: Kicking, Spitting, Biting, Shooting, and More

What's wrong with this picture? The very people who care for the sick and the wounded are the prime targets of workplace violence in America? The truth is, nearly 75% of all assaults in the workplace occur in healthcare, according to the Occupational Safety and Health Administration (OSHA).[1]

And while shootings and violent rampages get much publicity, very little of this violence involves mass shootings or even killings. Hospitals, for example, suffer an average of 13 hospital shootings with injury per year,[2] but this is a tiny fraction of the 80,000 or so assaults against healthcare workers each year.[3]

Kicking, spitting, scratching, hitting, grabbing, biting, throwing objects, and making threats of violence comprise the vast majority of this violence. And 93% of it comes from patients or visitors, while fellow staff or former lovers are responsible for some workplace violence in healthcare, according to a 2014 survey.[4]

James P. Phillips, MD, an emergency physician now at George Washington University Medical Center in Washington, DC, says he was first assaulted as a resident in 2009.

At that time, a patient with hepatitis C spit blood in his face. Although police officers were at the scene, "I was never asked if I wanted to press charges," he recalls. And no charges were filed, even though Phillips had to undergo 6 months of testing before he would know that he had not contracted hepatitis C from the incident.

Five years later, he encountered another significant assault. When he asked an emergency department (ED) patient to stop screaming and cursing because there were children next door, she threw her mobile phone at him and spit in his face.

He still went ahead and treated her. This is the weird thing about healthcare violence—you're often expected to take care of the very person who just assaulted you. Phillips did decide to press charges this time, but the arrest did not take place until after the patient had left the hospital and arrived at home. She was then charged with felony assault.

No study has pinpointed exactly why healthcare has such high levels of violence, but experts point to the unique relationship between patients and caregivers, which doesn't exist in other industries.

"If you act like a fool in a bar, they throw you out, but if you act like a fool in the hospital, you still have to be treated," says Alan Butler, senior vice president for healthcare security at HSS, a Denver, Colorado-based company that provides healthcare security programs to hospitals and other healthcare organizations.

"Sometimes people do things in a hospital that they would not do anywhere else, and if they did do them anywhere else, they would be arrested," he says. Violent patients, however, are rarely arrested.

Some frustrated healthcare workers blame the doctrine of patient-centered care. "The healthcare system has become a hospitality business," wrote one healthcare worker, responding to a previous Medscape article on healthcare violence. "The customer is always right. If the patient or their family is abusive, the managerial response is: 'They have a lot of stress right now. You should be able to take it.'"[5]

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