The following op-ed was published on February 2, 2011 in USA Today.
Last fall, a surgeon at Johns Hopkins Hospital was shot by the distraught son of a patient for whom he was caring. The man later killed his mother, then himself. A week earlier, a patient in a Long Island, N.Y., hospital beat his nurse with a leg from a broken chair, causing serious injuries. The following month, a psychiatric technician at a Napa, Calif., state hospital was fatally attacked on the job.
This snapshot of violence against health care workers reflects a disturbing trend. According to a Bureau of Labor Statistics analysis published last year, almost 60% of assaults in the workplace occurred in a health care setting. Nearly three-quarters of these assaults were by patients or residents of a health facility.
No longer havens
Health care settings have been traditionally thought of as “safe havens,” open to anyone as a place to be protected and cared for. This is a trend worth watching. The Joint Commission, a national accrediting agency, soberly noted last year that “health care institutions today are confronting steadily increasing rates of crime, including violent crimes such as assault, rape and homicide.”Violence is most common in psychiatric facilities and emergency departments, but can also be seen in waiting rooms, long-term care centers and critical care units. Nurses are the most frequent targets. According to a 2010 survey from the Emergency Nurses Association, more than half of ER nurses were victims of physical violence and verbal abuse, including being spit on, shoved, or kicked; one in four reported being assaulted more than 20 times over the past three years. The survey noted that the violence seemed to be increasing at the same time the number of alcohol-, drug- and psychiatric-related patients was rising.
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Clearly, we must do better protecting those charged with healing the sick. Most hospitals have focused attention on controlling access with security personnel. They’ve also trained staff how to recognize agitated patients, de-escalate threatening situations and to routinely report such incidents. Some facilities and states have taken stronger steps. Detroit’s Henry Ford Hospital has installed metal detectors, and Massachusetts recently strengthened criminal penalties for assaults on health care providers.
Doctor-patient strains
But I wonder whether the rising tide of violence against doctors and nurses is more emblematic of a dysfunctional health system. Patients are learning that health care is a commodity. I see firsthand the deterioration of the doctor-patient relationship, as physicians are pressured to see more patients in shorter amounts of time. Patients are rightly frustrated, and some are lashing out.
Rita Anderson, a former emergency room nurse, successfully spearheaded New York’s 1996 campaign that made it a felony to assault a nurse. She told CNN, “People are just tired of waiting, or they are just angry that they’re not getting the care they feel is acceptable. Instead of saying something, their response is hitting, screaming, spitting, yelling.”
Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time, patients must realize that health care professionals are doing the best they can with an overtaxed health care system and should never resort to violence or abuse.
That shared understanding and cooperation is essential if we hope to restore our health care institutions to the safe havens they were meant to be.
This essay is cited in the KevinMD record on violence against health care workers.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
