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Join Harry Severance, an emergency physician, as we delve into the alarming rise in violence against health care workers. We’ll explore the root causes of this issue, the impact on health care professionals, the implications of underreporting, and the urgent need for preventive measures.

Harry Severance is an emergency physician.

He discusses the KevinMD article, “Leaders advise us to accept it as a job norm: violence and abuse in the health care workplace.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast, and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Harry Severance. He’s an emergency physician, and today’s KevinMD article is “Leaders advise us to accept it as a job norm: violence and abuse in the health care workplace.” Harry, welcome back to the show.

Harry Severance: Thank you, glad to be here.

Kevin Pho: So you were on last summer talking about violence against health care workers, and you wrote about it again in your most recent KevinMD article. So let’s jump straight into that article and tell us what it’s about.

Harry Severance: This article, as you noted, is a follow-up to my earlier work. It’s an area where I concentrate in my work with multiple societies and organizations addressing issues in our health care workplaces, and violence is now becoming, for many, a predominant issue.

What I’ve been finding, and I’ll digress slightly, and I’ve been doing this for several years, for a variety of reasons I’ve had people reach out to me and come and say, I want to get out of health care, or should I get out of health care, what are my options?

And more and more recently, which led me to write this most recent article, I’m hearing from doctors, nurses, other health care professionals. Now, this really rocked my world, when I’ve had medical students reach out to me and say, I don’t think I want to do this anymore.

But violence is becoming, evidently, a tipping point, where people tell me, well, they put up with the other travails of our current health care workplace, but when they were assaulted, or their family member, their spouse was assaulted who was also a health care worker, or their colleague, or they viewed it, all this seems to be, that’s a bridge too far, I’ve had enough, I want to leave.

And most recently the thing that caused me to visit this again is, I’m now having people at all levels tell me, these are assault victims, when they go to try, their hospital, the district attorney’s office, are all telling them, we don’t want you to do, the hospital doesn’t want this, that’s bad publicity. The DA’s office has told several of the people I’ve talked to, why bother us with this? We’re stressed as it is, we’ve got lots of work to do, this is just a norm, you need to just get used to it, this is part of your workplace.

I don’t think that should be part of our workplace. As I look into it, I find again more and more doctors and nurses and other health care professionals are finding, this is the straw that breaks my back, I can’t do this, I don’t feel safe, I want to find a safe career, how do I migrate and how do I move?

When I started looking at some of the data, and realizing how many people are leaving health care, doctors, nurses, and others, and that even now hospitals are closing, currently mostly rural but increasingly into suburban and urban areas, because they can’t reliably get enough or afford the doctors and nurses to keep their service lines open, so they’re financially upside down. So this has a domino effect throughout our health care system, which means more and more patients are going to find they have little or no access to health care.

So I think it’s a critical problem. And I find that when our leaders have become callous and are promoting the idea that you need to just get used to this, that’s a serious problem that could again domino down to lack of health care for a huge number of our citizens.

Kevin Pho: Now, for context, what are some stories and examples of violence against health care workers that you’re hearing about?

Harry Severance: I had one couple that neither one of them have personally suffered violence. He’s an emergency physician, she is a nurse, working in the same, it’s a big safety net referral hospital. But both of them have witnessed their colleagues suffering violence, in one case an assailant with a knife, fortunately the knife was taken away from him. The nurses had multiple colleagues pushed, hit, shoved, knocked down.

The thing that really tripped their trigger was, she’s now pregnant with their third child and they have two other children, I believe one and three. So they both now fear each other going to work, telling me, what if my spouse doesn’t come home, what if I get a call, they’re in the ICU or they’ve expired? So they both want the other to find another job.

Another episode, a nurse practitioner was walking down a hallway, came around a corner, and was blindsided, attacked by a patient who was, I guess for whatever reason, out in the hallway, trying to be stopped by, I guess, security. But he attacked her, and in the process she was hurt badly enough that she had to be admitted. She recovered physically but is now undergoing counseling therapy and physical rehab. She tells me the hospital approached her, we will pay all your bills, all your counseling, but please sign this nondisclosure, we don’t want you talking about this. And she said they literally said to her, this is quote, bad for business, end quote.

Third episode, I’ve had a medical student recently approach me, I believe he’s a third-year med student, saying, are there options for him to migrate into something else? And I asked what’s driving this process, and he said that violence is something that the medical student group and the premed group where he’s located, that’s become a dominant topic in many of their discussions. And I said, oh. And he said no, that’s not the tipping point for me.

He said his parents called him and asked him if he’d recently heard from, and I won’t mention a name, but it’s a person that this medical student knew since he grew up, it was a family down the street. This young man, the person down the street, was someone he had modeled himself after. He had been very successful, high school, college, gone to medical school, now I believe his residency or fellowship. And his parents asked him, did you hear what happened to, let’s say Jim? The medical student said no. And they said, well, Jim was in a room with a patient having to deliver some bad news, and the family assaulted him and he had to be hospitalized for his injuries.

And this young man, the medical student talking to me, basically this rocked his world. He had modeled his whole life after this. And he said, I’m going into health care to help people, and these very people are turning against us. I don’t think I want to do this anymore.

And that really caught me, that’s the first time I’ve had a medical student reach out and say I want to change my career. And I went and looked to see, is there more? And I found an article published, I believe, by the AAMC, that notes that 25 percent of current medical students are seriously thinking of not completing their medical education. And 61 percent of current medical and nursing students say in this study that they will finish their diploma, but they do not plan to manage or touch patients. They’re going to go into administration, into research. Again, I think these are some frightening statistics about what the future, the near future, of our medical staffing may hold.

Kevin Pho: Now, when you tell me the story about that health care worker who was assaulted and the hospital made her sign a non-disclosure agreement because it’s bad for business, is that an isolated incident? How common does that happen, to your knowledge?

Harry Severance: When I’ve looked and I’ve tried to review, I don’t see a lot of publications that specifically target that. I did see an article with another physician who, as I mentioned, he was assaulted, the hospital tried to encourage him to not pursue this. He wanted resolution, he filed a complaint. The DA’s office, again I mentioned this earlier, said to him, why are you doing this, this is just part of your job these days.

And I’ve now heard three or four incidences of people, or reading about this. But I suspect, in my society meetings, that this is much more prevalent than we even see published at this point. And as I noted in the article I wrote for you, only 30 percent of all these events ever make it to any news media. So I suspect it’s a much, much more prevalent problem than we’re seeing. It’s the tip of an iceberg.

Kevin Pho: And the stories that you said earlier about how legal authorities, district attorneys, saying that they can’t handle more cases about health care workers being assaulted on the job, how common is that?

Harry Severance: Again, I’ve got the reports of people coming to me and telling me that. But when I talk in my society groups, I get the sense that more and more of my colleagues are sensing that when they talk to their hospital leaders, politicians, legal people, that there is more of a sense of, I guess I’ll use the word callousness, that this is, why are you making a big deal out of this, this is just part of your job.

I believe I noted in an article, I found one political leader in a visit to DC that basically told me, he said, doctors and nurses aren’t tough enough, you need to be trained in toughness like I was in the Army. And again, sensing that, why are we making a big deal out of this, it’s just part of our job.

So again, I don’t have exact statistics on how prevalent it is. I just suspect it’s evolving and becoming a more prevalent reality in our workplaces, unfortunately.

Kevin Pho: So you’re saying that the evolving attitude among those in authority is that health care workers should expect to be assaulted at work, correct? Now, for those who did speak out, I’m not sure what kind of stories, did they receive any push back when health care workers told their stories in public about being assaulted?

Harry Severance: That I don’t know. I haven’t heard them tell me that there was a negative response. There was resistance, as I said, through the system of trying to meet resolution, but no one has come and told me that they’ve received threats for speaking out as of yet. I’m hoping that’s not going to occur, but I’ve got my fingers crossed.

Kevin Pho: I’m just speculating, if health care workers, for instance, refuse to sign nondisclosure agreements, would that put their job in jeopardy if they choose to speak out about something that happens in the workplace?

Harry Severance: Yeah, I’ve not had, I guess I’d use the word client, come and say they’ve refused to sign the agreement. So yeah, I don’t know yet.

Kevin Pho: So from the health care worker perspective, what more can be done? How can they protect themselves against assaults in the workplace?

Harry Severance: It’s a difficult topic. Many states, and like I said, I speak to congressional leaders in DC, and both in the state in which I clinically practice, Tennessee, and many states have now either already enacted or are in the process of enacting harsher penalties for those who attack, assault health care workers. And that’s a step in the right direction.

But one thing I feel is that many of these assaults are not planned events. Certainly in the state where I live there was a physician who was shot and killed in his office, and that was a planned event. The assailant came in intending to do harm for what he felt was, he had been wronged by that clinic.

But many of these events are people who are having a bad day, and something overwhelms them, and it’s not planned. Now, many of them may be carrying some type of weapon, so subconsciously you could say maybe they’ve made some decision that I’m going to use that. I in fact have had, we’ve had two incidents recently of patients in the clinic where I work carrying handguns. They’ve shown them to me. They had some illogical reasons why they have them. But when we have people with weapons and they’re having a bad day, it’s usually not going to lead to a good outcome.

So does harsher penalties, putting them in jail for a long period, will that dissuade them from performing those events? I’m not so sure it will.

So then we get down to, well, what are the standard prevention tactics? Security. We see in our airports, TSA, the metal detectors, the inspections, security officers with guns. But I hear from the hospital leaders, they don’t want to do this.

Now, if they’re all on the same playing field, if a federal agency says every hospital has to have metal detectors, armed security guards, then they said yes. But what I’m hearing, and I’m even talking to some of my local leaders, if one of the hospitals, say in my community, were to get highly secure about whatever the standards might be, metal detectors, armed security guards, stuff like that, they perceive loss of market share. They perceive that patients and families see that as unfriendly, the hospital right down the street is not doing that, so they’ll migrate to that less aggressive hospital. Again, these people tell me, well, if everybody’s on the same playing field, we’ll do what we need to do, but we want all hospitals to be participating.

When I talk to Congress, what I’m hearing is many of our federal leaders and even state leaders do not want to increase federal bureaucracy. So they are not very eager for increasing federal laws that mandate hospitals, high security, all this kind of stuff.

So now we’re left in a quandary, where the hospitals perceive themselves as in a bind. If they protect their workers, they lose market share, because no one’s stepping up and saying this is a new standard. And we have our federal leaders saying we don’t want more bureaucracy. So it’s very difficult.

Are there some answers to this? Maybe. Interestingly, there’s no research on any of this. There’s no research that I can find in health care that says that the standard security items, like metal detectors, armed security guards, does that have an effect on reducing violence in the health care workplace? We would assume it does, but that’s not known.

What about signage? What about putting up big signs warning, if you attack a health care worker you’re going to jail? Again, that might affect those that are having a bad day and are thinking maybe I’ll hit somebody. But we don’t know, there’s no research.

One idea I had that I’m trying to start floating is, what about a law? We have whistleblower laws for those in any business and industry that see malfeasance going on, who can report this and be protected from retribution. What if, again, hospitals don’t want workers to report violent episodes, what if the states passed whistleblower laws that said that if a doctor, nurse, or other health care worker is assaulted in any manner, they are allowed to go report that and do not get any retribution from their employer? Would that be a way to level a playing field? I’m not sure, but it’s something I want to try to start investigating.

But like I said, right now, because of the reasons I mentioned, there are not a lot of easy answers to solve workplace violence at this point.

Kevin Pho: We’re talking to Harry Severance. He’s an emergency physician. Today’s KevinMD article is “Leaders advise us to accept it as a job norm: violence and abuse in the health care workplace.” Harry, let’s end off with some of your take-home messages to the KevinMD audience.

Harry Severance: Some of my take-home messages would be, if we allow health care workplace violence to proceed, we become inured to it, become callous and just say this is part of your job, I think, as I’m starting to see, the young bright minds, potential future doctors, nurses, mid-levels, who are highly bright, highly adaptive, are simply going to say, I’m not going into health care, I’m going to seek an alternative, a safer career. Very logical.

We also know there’s already a huge shortfall in the numbers of doctors and nurses and mid-levels that we need, and we’re getting into a huge population bubble with the baby boomers retiring and needing increased health care. So as more future doctors and nurses choose to not become doctors and nurses, this just further aggravates the situation.

Jumping several leaps, my final thought, a corollary would be, we hear the idea of Dr. AI or nurse AI, and there’s much, and probably reasonably so, resistance to that. There are some studies that have shown in, like, telemedicine areas, Dr. AI was perceived, and these are small studies with only a few hundred participants, but Dr. AI was seen as being more empathetic and providing better answers than the live physician on the phone.

Taking that several leaps, what if in the near future, especially in our rural areas, we find that whole areas of states have little or no human health care? Does Dr. AI then become a more acceptable alternative, and will state governments start to turn to Dr. AI, especially in areas like telemedicine, when it’s a choice of no doctor or AI doctor?

And again, waxing science fiction becoming reality, could that be an area if we find ourselves in, in even the next five or 10 years, if we don’t aggressively address these health care violence problems, which right now it seems some of our leaders don’t want to do?

Kevin Pho: Harry, thank you so much again for coming on the show and sharing your time and insight.

Harry Severance: Thank you.