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Psychiatrist Devina Maya Wadhwa discusses her article, “How abuse in health care is driving doctors out of medicine.” In this episode, Devina shares her experiences as a physician working in acute care settings, where she encounters racial, verbal, and physical abuse while treating vulnerable patients. She delves into how prolonged wait times, outdated hospital policies, and systemic pressures create environments ripe for abuse, driving physician burnout and prompting many to exit the profession. Devina explores the emotional toll on doctors, the decline in patient care quality, and the urgent need for solutions like anti-abuse policies, enhanced medical training, and public awareness campaigns. Listeners will discover actionable steps—such as fostering safer workplaces and promoting mutual respect—to protect physicians and strengthen the health care system.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Devina Wadhwa. She’s a psychiatrist in Canada. Today’s KevinMD article is “How abuse in health care is driving doctors out of medicine.” Devina, welcome back to the show. Thank you. Thank you very much. All right, tell us what your latest article is about.

Devina Wadhwa: So my latest article was inspired by a tough day at the hospital or at the office, and I just started to reflect on what clinicians face nowadays. It stemmed from personal experience of having a day where I faced a lot of verbal abuse and racial abuse, and I think I just felt extremely overwhelmed and disempowered. I started to look at what’s out there in terms of clinicians reporting and describing suffering from abuse on the job, and I was shocked by how pervasive it is. I sometimes feel like “abuse” is a very strong word, but at the same time, I think it is the correct word.

Clinicians are facing various types of abuse on the job, and it feels like the prevalence has increased significantly since I began training. I feel like it spiraled even more so after the COVID pandemic. This article really talks about this lens of: it’s not OK to be abused on the job. It’s not OK if you walk into a bank to have the teller get yelled at, so it should be exactly the same when people are seeking care in hospital or clinic settings—to be able to treat each other with respect. That respect is degrading, and a lot of it has to do with frustrations that patients face on the front lines in emergency rooms, waiting for hours and hours. By the time you do see your patient and try your best to provide the best care, they likely have escalated to a point where you’re on the brunt-receiving end of abuse.

I speak from a physician lens, but my nursing colleagues describe the same sorts of traumas they experience on the job. That was the inspiration for the article: vocalizing my experience and connecting with other clinicians who have felt this way. The thing that I always get stuck on is, how do we make positive change? For me, writing and putting the opinion out there is one of the ways to bring awareness, and talking to you on this podcast is another way for me. So that’s what inspired this article.

Kevin Pho: We’re reading all the time about these escalating numbers of both verbal and physical abuse against everyone in health care—those on the front lines, clinicians, nurses—and it’s becoming a dangerous place for us to practice. In your case, tell us a little bit about your situation, where this abuse occurred, as much as you can tell us.

Devina Wadhwa: Absolutely. Keeping every aspect of the patient’s story confidential: as an acute care psychiatrist, servicing the emergency room is one of the things I do frequently. I had a very angry patient who was coming into the hospital, seeking respite from being homeless and living in the shelter-based system. We connected him to social work services and tried to improve his living situation. However, that still meant that he was going to be living in a shelter situation—but just a “better” shelter, for lack of a better word. He was extremely furious and threatened to kill me. It involved the police and getting a restraining order.

I live in what I call a small-to-medium-sized town of about 100,000 people. When I finished my day, I had gone to do some errands, and I checked the mirror of my car to see if this individual was there. I actually felt scared. It may sound dramatic, but walking into the store, I was a bit hypervigilant, and I thought, this is not OK. It’s not the first incident where I’ve been threatened by a patient or racially abused. I’ve experienced quite a bit of racial abuse on the job as well, but this one really affected me. I felt unsafe in my life, in my community, wondering what if this person was here and what they could potentially do to me.

I started thinking about psychological safety and the importance of feeling psychologically safe in your life. It struck me that I didn’t feel that way. That was a big “aha” moment. Changing jobs isn’t the solution; changing towns isn’t the solution. I don’t know what the solution is, but I bet it happens to a lot of clinicians all the time. Tying this into my last article around burnout, I think experiences like these also make us feel like, wow, am I really serving a purpose by doing this job when it’s impacting my life in this way?

Kevin Pho: When this happened to you, tell us the type of support you received from your colleagues and hospital administration.

Devina Wadhwa: I do have to say, I work in a fantastic team of acute care psychiatrists, and the leadership of my team was extremely supportive. We developed a crisis plan where, if this person were to re-present, I wouldn’t be the psychiatrist having to see or look after him or be consulted. We were going into a long weekend, and I was covering the entire long weekend, so we safety-planned that if this individual did come in, what would happen in terms of who would see him if a psychiatric consultation was requested.

The emergency team was also very supportive, saying they would be able to look after the patient. If a psychiatric consultation was needed, the next available psychiatrist would see him. I was really impressed. When I brought this up to the hospital team, it was very well received, and I was very well supported. That was great. It was wonderful.

Kevin Pho: After receiving these death threats from this particular patient, how has that affected your patient interactions going forward? Is this incident in the back of your mind when you talk to other patients?

Devina Wadhwa: I have a hypervigilance on the job in general. Through residency training in Toronto, you’re always taught to lead with empathy but be mindful of your safety. Unfortunately, I have had the experience of being assaulted on the job physically, so I always carry some hypervigilance. I think the difference with this incident was feeling that hypervigilance outside of being on the job—for instance, in the community—and having these thoughts like, what if this individual knows where I live?

I call those “silly thoughts” sometimes, because I wonder if I’m overreacting. Maybe. Or is this me trying to justify my emotional state? I’m not sure; there’s some reflection to do there. But I am empathic, and yet I’m hypervigilant.

Kevin Pho: Tell us what you would like to see in terms of better supporting clinicians. Or what more needs to be done to support frontline health care workers after they receive abuse, or even to prevent abuse in the first place? What more needs to be done?

Devina Wadhwa: I love that question, and that’s what I’m processing. I’m not sure if your viewers are aware of an incident in Halifax around safety. Some emergency rooms are now considering having people walk through metal detectors. Is that an extreme move toward keeping emergency rooms safe? I don’t know, but the incidents of aggression have gone up significantly.

I think, at the heart of it, it comes down to policy change. For example, is there a policy with the College of Physicians about whether physicians can say, “I don’t feel safe, and I can’t see this patient?” How do you navigate that? To be transparent, I haven’t dug into it fully. I did call the CMPA, our Canadian Medical Protective Association, to ask: what are my rights as a clinician if this patient were to be present?

Hospital policy and health policy in general should clarify how clinicians can feel safe saying, “I don’t feel safe.” How do we navigate not feeling safe and providing patient care at the same time? We went into this job to help people, but if you’re not feeling safe, how can you say no to helping? It’s complicated.

We always talk about policy change at the bigger level. On the smaller level, for frontline individuals like myself, I feel like bringing awareness to these issues and not feeling ashamed to talk about them openly is key. I bet I’m not the only one who feels this way. I have to be transparent: I’m going to use the word shy. I’m not shy, but I was a bit shy to come on the podcast today and talk about this. There’s a vulnerability in talking about not feeling safe and not feeling strong enough, feeling psychologically vulnerable in my community. I’m sharing that because I think there are people out there who probably feel the same way.

Kevin Pho: I completely agree with you. I think there is a culture of silence when it comes to assault and abuse against health care workers. In the U.S., there are stories where health care administrators often don’t like to publicize these cases because, if they feel their institution isn’t safe—where their clinicians are being attacked—that’s really not the best image for those hospitals. There’s a culture of suppression when it comes to speaking out about these abuses.

You mentioned the word “shame,” being a little bit shy about sharing your story. Talk about how important it is for the rest of us listening to you to know these things are happening. Tell us why that’s so important.

Devina Wadhwa: I don’t think I’m alone, and I don’t think we should suffer in silence. The biggest transformation comes from a community of togetherness. The more voices that speak up about it, the more tangible the change can be. When I was writing this article, I tried to look at the data. There isn’t much out there in terms of individual stories. But individual stories become a collective, and that’s why it’s so important to share.

I’m hoping more people will share their experiences so we can say, “Hey, something needs to be done.” As health care workers—physicians, nurses—we need to feel safe to do the job. We need physical and psychological well-being to provide good care. Society needs to understand and appreciate that.

Kevin Pho: Anecdotally, do you personally know—or have you heard through your network—about other colleagues who have been verbally assaulted or abused, or even nurses and others across the health care spectrum who have received abuse? Tell us anecdotally some of those stories.

Devina Wadhwa: I can tell you, thinking about my amazing team and the locum psychiatrists who come help us: every single clinician has experienced abuse. Every single one. Ranging from statements like “Get me a white doctor,” or “Aren’t there any white psychiatrists practicing in this city anymore?” to being charged at because people are upset.

I do want to say, people suffering from acute mental illness who are in crisis can sometimes be really distressed, really upset. In psychiatry, there’s a level of acceptance in knowing that if someone is experiencing psychosis and feels paranoid, they may not feel safe with you, and they may try to run toward you or run away from you. It’s almost an acceptance that, yes, people with acute psychosis or severe mania can be unpredictable, and you plan for that. I think it’s the patients who are very measured and deliberately threatening or emotionally hurting you that really get to you. Every single clinician I know has experienced abuse, from horrific verbal, profane language to physical assault as well.

Kevin Pho: You mentioned earlier that you had a level of personal hypervigilance, and you obviously talk about how wonderful your team is in supporting each other. But not all clinicians have the traits you have, and not all clinicians have that team. For those who are listening to you today and may be the recipient of verbal or physical abuse for the first time, what are some tips you could give them? What are some pieces of advice to help them get through that traumatic incident?

Devina Wadhwa: Talk about it. We can be very siloed in practice. I find new grads have such an isolating time, where you feel like, “I’ve graduated; I should know what to do.” What’s always helped me in life, and will continue to help me, is having amazing mentors. I have a wonderful mentor whom I always turn to. I called him and said, “Can I just talk? I’m feeling really overwhelmed and scared.”

So, talk about it. Be mindful that medicine is wonderful, but it’s not always safe. You don’t have to become hypervigilant—I don’t think that’s a good state to be in—but be mindful about your safety. If you’re saying, “I’m sorry, I can’t prescribe you opiates,” be mindful of whether you’re alone in a room. Listen to your gut. The number of times I’ve ignored my gut—that’s when bad things have happened. Your body tells you things, so talk about it, share your story, find safe places to share your story, and just be mindful that sometimes the patients we’re trying to look after can be the ones who subject us to abuse.

Kevin Pho: We’re talking to Devina Wadhwa. She’s a psychiatrist, and today’s KevinMD article is “How abuse in health care is driving doctors out of medicine.” Devina, let’s end with some take-home messages that you want to leave with the KevinMD audience.

Devina Wadhwa: Thank you. As mentioned, use your voice because our voices are powerful, and when we create a collective, change can happen. Access mentorship if you’re struggling with abuse. It’s not normal to be abused on the job. It’s not OK to be abused on the job. Talk about it. Seek help if you’re feeling scared, vulnerable, or anxious, because it is a normal reaction to being abused on the job. So, thank you—those are what I’d like to leave your audience with.

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

Devina Wadhwa: Thank you. Thank you very much.