Threats and Aggression
"The reality is that most threats never come to fruition," Butler says, "but people remember threats for a long time. Things like: 'Someday I'll find you, I don't know when or how, and you'll never forget me.'"
Even when there's no grave injury, repeated physical and verbal aggressions, day in and day out, can produce trauma and lead to burnout, says John Battaglia, MD, a psychiatrist in Madison, Wisconsin, who treats patients with severe chronic mental illnesses and has written about healthcare violence.
"At least a third of mental health workers who have been assaulted report subsequent psychological symptoms related to the incident," he says.
A psychiatrist commenting on a previous Medscape story on healthcare violence wrote that, after being assaulted for the third time in 2013, "I still wake with nightmares, have trouble sleeping and depression. I have left direct patient care."
Younger workers are more likely to suffer verbal abuse. One study found that healthcare workers aged 20 to 29 experienced a significantly higher number of nonphysical violence than those aged 60 or older.
"It's easy to yell at a 25-year-old nurse and make her cry," says Monica Cooke, a risk management consultant at Annapolis, Maryland-based Quality Plus Solutions, which helps organizations evaluate their risk for violence. "Young people are not as skilled at setting limits and don't feel they have as much competency to manage other people's behavior."
Can You Spot Violent Patients in Advance?
The best indicator of violence is having committed violence in the past. "History of violence is definitely a risk factor to pay attention to," Battaglia says. Detection is facilitated by flagging violent patients on electronic health records (EHRs) and looking for these notes when patients come back in.
Patients with severe mental illness, such as schizophrenia or bipolar disorder, also have a high propensity for violence, but most of them do not get violent, so it would be unfair to flag everyone with a serious mental illness, Battaglia says.
Drug use and head injuries have also been linked to violence. One study found that half of assaults in the ED involved drugs or alcohol. Other signs of possible violence are gang activity, domestic disputes, presence of weapons, and police custody.
Battaglia suggests asking the patient's family or EMTs bringing the patients how the patient was behaving: Were they being destructive on the way? Were they engaged? Were they talking? "If they were not talking at all, that's a big red flag," he says. It suggests that the patient is very angry.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Leigh Page. Patient Violence Against Physicians: What You Can Do - Medscape - Apr 30, 2019.