Patient aggression towards receptionists working in Australian general practice is a “serious workplace safety concern,” according to new research.
The literature review, published this week in Family Medicine and Community Health, included 20 relevant studies (involving 4107 participants, of which 21.5% were GP receptionists) and found that every study reported that patient aggression towards receptionists was frequent and routine in general practice – particularly verbal abuse, hostility, and the use of racist, ableist and sexist insults.
Receptionists experienced disproportionately more acts of patient aggression compared with their clinician and practice colleagues, with anecdotal evidence that the COVID pandemic has exacerbated this.
Nine studies reported acts of physical violence towards receptionists, and while these occurred much less frequently than verbal abuse, some acts were serious, including being hit, shaken, held at gunpoint, stalked, and threatened with a razor blade.
Lead author Dr Fiona Willer, from the University of Queensland, said patient aggression towards reception staff was a serious workplace safety concern for general practices and negatively affected the health-care sector more broadly.
“Not only does it affect the wellbeing of the individuals concerned, but it also has operational effects by boosting levels of workplace absenteeism and the numbers of staff leaving the health workforce,” she said.
“Medical receptionists are core members of high-quality primary care teams, critically important to the functioning of clinics and ensuring patient safety and experience. Clearly, strategies to support general practice receptionists are warranted and justified.
“Receptionists typically provide patients with their first and last interactions, and act as gatekeepers to their care.”
She said patients’ perceptions of the ‘helpfulness’ of reception staff had been identified as the second most important driver of their overall satisfaction with a GP practice.
Receptionists most often attributed the triggers for patients’ aggression and hostility to frustrations with appointment scheduling and admin systems, errors, delayed access to doctors and prescription refusal.
Receptionists usually tried to placate patients to avoid the situation from escalating, but at the cost of their own wellbeing and workplace productivity.
Patient aggression was the most difficult part of their role, with such incidents prompting a range of negative feelings and in the long-term, direct, and indirect exposure to repeated patient aggression was reported to lead to burnout and fatigue.
Strategies that minimised pinch points for patients, such as streamlined and flexible scheduling systems, early availability of appointments, and consistent patient management practices, seemed to curb the likelihood of aggressive/hostile behaviours.
And receptionists felt better able to manage patient aggression if they had been given relevant training, had confidence in their de-escalation skills, and if they could refer to formal policy and rely on back-up from management and clinical colleagues.
There was, however, little coordinated support for general practice reception staff on the receiving end of patient aggression, with only a small proportion given professional counselling.
“While the main duties of general practice receptionists have remained largely unchanged since the role’s inception, in recent decades receptionists have been called on to perform tasks that carry clinical, medicolegal and ethical implications,” Dr Willer explained.
“These include triaging patients as they call or arrive, providing ‘emotional management’ in the waiting room, providing first aid, relaying medical reports, and even assisting with certain medical tasks.
“Yet despite their significance in the healthcare landscape, role complexity and risks, becoming a receptionist in a general practice requires little formal qualification and the extent of training offered is minimal and typically done ‘on the job.’
“These job characteristics may create a disconnected and relatively voiceless workforce. Evidence-based strategies to prevent, manage, and mitigate the harms of patient aggression towards general practice reception staff are urgently needed.”