When I was an internal medicine resident, a delirious patient kicked me in the gut from his hospital bed. Later in training, I just missed being on shift when a man entered the emergency room with a handgun, taking hostages in an exam room, facing off with police and even firing a few warning shots into the ceiling; he later gave himself up and let the hostages go. In my first job, a young patient saw me in a clinic appointment after first meeting only weeks earlier; she was frustrated with a lack of diagnosis after years of nonspecific symptoms with a normal diagnostic work-up, declaring, "You're the devil!" and then continued to make other expletive remarks.
Workplace violence against healthcare workers is most commonly verbal, but physical violence, including assault, battery, or sexual harassment, are most frequently perpetrated by patients or their caregivers. Permanent disability or death by homicide are rare. The healthcare sector is second only to law enforcement in encountering violence. In the U.S., it was estimated in 2014 that violence perpetrated by patients in hospitals accounted for 93% of all assaults against employees.
Unfortunately, violence in the healthcare workplace is an underrecognized, underreported yet significant occupational risk of caring for people who are ill. Patients may be suffering, experiencing vulnerability or a loss of control. I tend to believe that a far smaller number perpetrate violence against their health professionals out of criminal or malicious intent. Certain mental health or substance use disorders, for example, could cause pathological, violent behavior. The patient who had kicked me in the ICU was experiencing severe alcohol withdrawal syndrome.
I wrote in my first Observant column about the imperative to “heal our healers.” Preventing workplace violence, through accurate surveillance, personnel training, institutional support, and public policy, among other interventions, are a part of that imperative. I’m fortunate that all I received was a tough physical (or verbal) reminder of the risks of being a doctor. But let’s not wait to react after serious harm happens to do more to protect and support our healthcare workforce.
Tiffany Leung, assistant professor at the Faculty of Health, Medicine & Life Sciences