Aggression Toward Healthcare Providers Common During Pandemic

Carolyn Crist

July 11, 2022

Verbal and physical violence against healthcare personnel in Latin America has been highly prevalent during the COVID-19 pandemic, according to a new survey.

After an aggressive event or abuse occurred, 56% of providers considered changing their care tasks, and more than a third considered quitting their profession.

Dr Adrian Baranchuk

“Aggression of any sort against healthcare providers is not a new social phenomenon, and it has existed as far as medicine and healthcare is reported in literature. However, the phenomenon of aggression against healthcare providers during the pandemic grew worse,” senior study author Adrian Baranchuk, MD, a professor of medicine at Queen’s University in Kingston, Ontario, Canada, told Medscape Medical News.

The study was published online June 29 in Current Problems in Cardiology.

Survey Snapshot

Baranchuk and colleagues, with the support of the Inter-American Society of Cardiology, developed a survey to characterize the frequency and types of abuse that frontline health professionals faced. They invited healthcare professionals from Latin America who had provided care since March 2020 to participate.

Between January and February 2022, 3544 participants from 19 countries took the survey. Among them, 70.8% were physicians, 16% were nurses, and 13.2% were other health team members such as administrative staff and technicians. About 58.5% were women, and 74.7% provided direct care to patients with COVID-19.

Overall, 54.8% of respondents reported acts of aggression. Of this group, 95.6% reported verbal abuse, 11.1% reported physical abuse, and 19.9% reported other types of abuse, including microaggressions.

About 13% of respondents reported experiencing some form of aggression daily, 26.4% experienced abuse weekly, and 38.8% reported violence a few times per month. Typically, the incidents involved patients’ relatives or both the patients and their relatives.

Nearly half of those who reported abuse experienced psychosomatic symptoms after the event, and 12% sought psychological care.

Administrative staff were 3.5 times more likely to experience abuse than other healthcare workers. Doctors and nurses were about twice as likely to experience abuse.

In addition, women, younger staff, and those who worked directly with COVID-19 patients were more likely to report abuse.

‘Shocking Results’

Baranchuk, a native of Argentina, said people initially celebrated doctors and nurses for keeping communities safe. In several countries across Latin America, for instance, people lit candles, applauded at certain hours, and posted support on social media. As pandemic-related policies changed, however, healthcare providers faced unrest as people grew tired of wearing masks, maintaining social distance, and obeying restrictions at public spaces such as clubs and restaurants.

“This fatigue toward the social changes grew, but people didn’t have a specific target, and slowly and gradually, healthcare providers became the target of frustration and hate,” said Baranchuk. “In areas of the world where legislation is more flexible and less strict in charging individuals with poor or unacceptable behavior toward members of the healthcare team, aggression and microaggression became more frequent.”

Dr Sebastián García-Zamora

“The results we obtained were more shocking than we expected,” Sebastián García-Zamora, MD, the lead study author and head of the coronary care unit at the Delta Clinic in Buenos Aires, Argentina, told Medscape.

García-Zamora, also the coordinator of the International Society of Electrocardiology Young Community, noted the particularly high numbers of reports among young healthcare workers and women.

“Unfortunately, young women seem to be the most vulnerable staff to suffering violence, regardless of the work they perform in the health system,” he said. “Notably, less than one in four health team members that suffered workplace violence pursued legal action based on the events.”

The research team is now conducting additional analyses on the different types of aggression based on gender, region, and task performed by the healthcare team. They’re trying to understand who is most vulnerable to physical attacks, as well as the consequences.

“The most important thing to highlight is that this problem exists, it is more frequent than we think, and we can only solve it if we all get involved in it,” García-Zamora said.

‘Complete Systematic Failure’

Healthcare workers in certain communities faced more aggression as well. In a CMAJ Open study published in November 2021, Asian Canadian and Asian American healthcare workers experienced discrimination, racial microaggressions, threats of violence, and violent acts during the pandemic. Women and frontline workers with direct patient contact were more likely to face verbal and physical abuse.

Zhida Shang

“This highlights that we need to continue the fight against misogyny, racism, and healthcare worker discrimination,” lead study author Zhida Shang, a medical student at McGill University in Montreal, Quebec, Canada, told Medscape.

“As we are managing to live with the COVID-19 pandemic, it is important to study our successes and shortcomings. I sincerely believe that during the pandemic, the treatment of various racialized communities, including Asian Americans and Asian Canadians, was a complete systematic failure,” he said. “It is crucial to continue to examine, reflect, and learn from these lessons so that there will be equitable outcomes during the next public health emergency.”

The study was conducted without funding support. Baranchuk, Garcí a-Zamora, and Shang report no relevant disclosures.

CPC. Published online June 29, 2022. Full text.

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