The results of a global research project that found violence and abuse towards general practice staff was widespread did not come as a surprise to Dr Cameron Loy.
The research found that despite such behaviours having an impact on both individuals and service delivery, interventions were under researched.
Dr Loy is a former RACGP Chair, has been a GP for 25 years and now speaks to his colleagues about managing violent and aggressive patients. He told Medical Forum that he had experienced “the full spectrum” of violence and aggression.
That included a patient getting in his face and yelling aggressively, another knocking him on the head with their bag, one patient’s partner king hit him and another agitated patient returned to the clinic with a knife after their appointment.
Dr Loy believed such behaviour was hidden from the social conversations that occur. The nature of the new research would suggest that has been the case.
What the research found
The University of Nottingham research is among the first of its kind. In the past, when researchers had looked at violence and abuse towards healthcare staff by patients, it had tended to focus on secondary care facilities such as hospitals, rather than general practice settings.
This research, published in the British Journal of General Practice, utilised 50 studies from 24 countries.
It showed that rates of violence and abuse by patients and the public towards general practice staff ranged from 13.8% to 90.3%, and career-long estimates were from 18.3% to 91.0%.
Verbal violence and abuse was most commonly reported, alongside physical violence, threats, and sexual. Less commonly reported were defamation, slander and vexatious complaints.
It found the abuse and violence had an impact on staff mental health, turnover intention, and service capacity.
It identified long waiting times and unmet patient demands as the most common factors.
GP’s unique role
“General practice is in a unique position that we get to enter some of the most private places of people’s lives, both their health and their homes and their relationships – all manner and all aspects of their lives,” Dr Loy said.
“We meet people often at the most vulnerable parts of their life and there are some people that just don’t know how to deal with that, and the way they deal with it is threats and punching.”
RELATED: Losing doctors to burnout – how to solve an ongoing problem
Dr Loy said while most patients did not cause any concerns and it was an “uncommon” occurrence, violent and aggressive behaviour at work could have a big impact on a GP.
“We’re not in a job where we expect violence. If you’re in some jobs, like if you’re a police officer for example, it’s understood you will likely be on the receiving end of some sort of expressed violence during your working life, because that’s the nature of policing,” he said.
“We’re not used to it, we don’t expect it, so when it comes out of the blue, and when we start to feel and experience it, it’s very confronting for healthcare professionals and GPs.”
Dr Loy said the offenders were not always those people might expect to be violent or aggressive, and that such behaviour often took GPs by surprise.
He added that while there was little data to show whether GPs were dealing with increased levels of violence, he could see there were certain factors contributing to the violence in recent times.
“Some people are just angry, they are they are looking for something, and they think that the way they’re going to get it is intimidation, threats, and violence and that is probably how they traverse their entire lives.
“Sometimes people are unwell so sometimes, particularly with psychiatric disease, you’ll have people who aren’t in their normal headspace.”
He said there also appeared to be a growing distrust of experts.
“The social contract between a doctor in their community and the trust that we are acting in our patients’ best interests, that we’ve done 15 years of education and 25 years of work and ongoing education in medicine, and that we know so much about it and understand it – that sort of community understanding is getting broken down hard and fast,” Dr Loy said.
RELATED: Doctors experience bullying, discrimination and burnout at WA hospitals
He said he believed the increased cost of living and people’s financial stress was sometimes playing a role in poor behaviour.
“We’ve got a society who is really suffering from cost of living,” he said.
“We’ve got a government that in pursuing its objectives and its political objectives can, and often does, paint general practices as being a problem, which feeds into it.
“For example, for clinics that haven’t signed up to the Medicare Bulk Billing Practice Incentive Program, it’s not infrequent for patients to come in and get upset that they’re paying a bill because the government told them it was going to be free.”
Trust your instincts
Dr Loy has taken a special interest in the factors around patient aggression towards GPs and spent time talking to other doctors about their experiences.
He himself has been caught off guard by a patient’s violence in the past.
“The most significant assault I had was when somebody caught me by surprise. They opened up my upper eyelid, knocked me out and broke some ribs when I was on the ground.
“And in that circumstance, I actually had other people in the room with me.”
Dr Loy said GPs should trust their instincts.
“It’s that that gut feeling which is often right on the money. If you feel at threat, you’re at threat, and at that point their only job is managing that threat.”
What can be done?
Dr Loy said while duress alarms may increase response times when a violent threat occurred, he had not seen evidence that their presence prevented violence in GP clinics.
He said each clinic should have its own approach to dealing with violent and aggressive patients and have processes in place to ensure any such behaviour is documented.
He said there is WorkSafe training in de-escalation tactics as well as resources including physical posters to hang in waiting rooms reminding patients there should be zero aggression in the clinic.
“The important thing is having an absolute zero tolerance and following through with that,” he said.
“We need to make it absolutely clear within clinics that anything that is aggressive, threatening, violent, that’s it. You no longer come to the clinic.
“I think when you let a little bit get through, there’s always going to be a group that will push that boundary.
“If you have to go from someone yelling and screaming, to a serious assault, that distance is shorter than nothing to a serious assault.”
Resources for managing patient violence and aggression are available here.
Want more news, clinicals, features and guest columns delivered straight to you? Subscribe for free to WA’s only independent magazine for medical practitioners.
Want to submit an article? Email editor@mforum.com.au