- Email: [email protected]
An epidemic of violence on medical personnel: are we prepared
Journal of Medical Colleges of PLA 28 (2013) 120-124
JOURNAL OF MEDICAL COLLEGES OF PLA www.elsevier.com/locate/jmcpla
An epidemic of violence on medical personnel: are we prepared ZHANG Han1, ZHANG Yan2* 1
The Five-year Program on Clinical Medicine, Second Military Medical University, Shanghai 200433, China 2
Department of Foreign Languages, Second Military Medical University, Shanghai 200433, China Received December 21, 2012; accepted January 14, 2013
Abstract The incidence of violence against doctors has been increasing, both in China and worldwide. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial medical malpractice or even no fault of theirs. The once glittering halo of medical workers is being shredded thanks to the stressed health system and a lack of evaluation for risk of violence of the patients. Modern China sees a wide disparity between industry standards in rural and urban areas. Peo ple seeking health care service are often scared, can’t get timely service and turn their anger towards those around them. To change a whole system in this giant nation is too hard a rock. Therefore, our focus is on the prompt awareness and preparation of a possible patient violence. The simplest approaches seem to be the most effective. Medical staffs should re-learn empathy on patients and be better trained on recognizing and reducing conflicts.
Keywords: Patient violence and assaults; Prevalence of aggression; Health care industry; Risk factor evaluation; Patient empathy
*
Corresponding author.
E-mail address: [email protected] (ZHANG Y.)
121
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
Being a doctor in China is by no means easy, 1. Introduction
and to some extent even dangerous. A national survey has indicated that the year of 2006 witnessed
Once upon a time, doctors were under their
9 831 disputes hurt 5519 medical personnel. In the
little halos. Thankful faces, grateful tears and
year 2007, 73.3% of the hospitals in mainland China
inspiring words, are those lightening the glitters of
have seen violence, threatening, abusive assault
the halos. Everything has changed. These years have
medical personnel; 59.6% of hospital patients were
witnessed a great depression, not economically, but
found dissatisfied with the treatment result, they
the status of the doctors. Health-care settings have
gathered at the hospital and became great threats to
been traditionally thought of as “safe havens”,
hospital staffs and other patients. Very often we hear
opening to anyone as a place to be protected and
doctors being molested, thrashed and abused by lay
cared for. Who would have foreseen a mounted
public for a trivial medical malpractice or even no
epidemic on medical personnel. Health-care staffs
fault of theirs. Thousands of medical staffs have been
are now victims of threat, violence and abuse,
victimized under their own patients. Some doctors
hospitals turned into battlegrounds and patients, who
described their lives as: Disease, Drug, Drink
are supposed to be saved from hurt, become mobs.
(alcohol), Divorce. Things need to be changed
Violence as a way of achieving justice is both
urgently.
impractical and immoral. Man cannot blame all those burst into violence because it is a natural gift given to us and a normal
2.2. A tragedy happened in October 2011 may partly annotate the vicious cycle
reaction to fear as a human being. What on earth unfortunately gives birth to violence is fear, which is
A calligrapher sued Beijing Tongren Hospital in
the root of the violence cycle. Sadness, anger, self
court for medical malpractice and stated that the
destruction and suffering, these are the four steps
hospital fabricated his medical records. Because of a
leading to violence.
laryngeal carcinoma that has locally metastasized, he was
2. Medical treatment disputes in China
admitted
to
the
otorhinolaryngological
department. Considering the mass spread, the surgeon cut off his vocal cord during the tumor
2.1. Medical treatment disputes in China increase at
resection with the preoperative consent of the patient.
a speed of 23% annually since 2002
Knowing the permanent loss of the ability to phonate,
122
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
he was at first under the shadow of sadness for not
follows consequently, as physicians are pressured to
being able to talk any more, then he got angry with
see more patients in shorter amounts of time.
himself, the surgeon, nurses, and everyone around
Patients are rightly frustrated, and some are lashing
him. “I became a dumb and disabled loser from a
out. China, as a special country with 80 percent of its
talkative and knowledgeable artist”, he wrote, “I just
population living in rural areas, the situation is
wanted revenge every day”, the China Youth Daily
bound to be even worse. A migrant worker in
reported. Finally he made his decision that it is the
Chaozhou, Guangdong province, stabbed one doctor
surgeon who should shoulder every outcome. This
to death and seriously injured two other hospital
trustful surgeon, as well as a kind woman was
personnel on 3 November, which renewed the debate
stabbed so severely on her arm that it was unclear
on strained doctor-patient relations.
whether she would be able to hold the scalpel again.
people rush into the metropolises for the sake of a
She was not out of danger until a nine-hour operation,
better treatment and the treatment ends up to be way
and was moved into intensive care.
below their expectance, this story would possibly
Once these
end as a tragedy: They might have staked all their 3. Violence is a symptom of health care
fortunate and even their credit and reputation, it has
dysfunction
to be a happy ending, otherwise, they have nothing left.
The uncomfortable truth in China has always been the giant population and the huge gap between
4. Patient violence is a global issue
the rich and the poor versus the nationwide insufficient health care. Modern China sees a wide
It is unfair to say that patient violence is a
disparity between industry standards in rural and
regional problem; and the grey cloud is now
urban areas, and the extremely low doctor-patient
worldwide, even in some of the most developed
ratio in the villages has made seeking medical care in
countries. In the US, according to a Bureau of Labor
the metropolises a trend and a must. In some rural
Statistics analysis published last year, almost 60% of
areas of China, there is only 0.47 doctor among 1000
assaults in the workplace occurred in a health care
people, that is to say, over 1200 citizens would have
setting. A survey from the British National Audit
on average one doctor. In European countries like
Office (2003) stated that violence and aggression
Germany
3.3.
accounted for 40% of reported health & safety
Deterioration of the doctor-patient relationship
incidents amongst healthcare workers (Oostrom and
and
France,
the
ratio
over
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
Mierlo 2008). Three-quarters of Canadian family
123
5. Advices that help
doctors say they suffered at least one incident of major abuse at the hands of a patient, according to a
Education and training in the evaluation and
new study. Australian medical association Victoria
management of potentially violent patients is often
vice-president said every emergency doctor would
minimal. Because of the complexity of such patients
have stories of violence, including in some cases
and the high intensity of the context in which they
being punched, kicked, scratched and threatened
can present, it is helpful to be prepared with
with knives or furniture.
knowledge and some plans for dealing with this
The simplest approaches would most likely be the most effective.
situation. An evaluation for risk of violence is needed at
The world-wide doctor-patient disputes did
the first contact with the patient, when violent
bring about some changes. Health-care orgnizations
thoughts are reported, and when there are pertinent
are busy taking actions to better protect their staffs.
clinical or behavioral changes. If a patient appears
To learn martial arts would be one way that makes
with some of these characters, he or she is more like
some sense. In Australia, some doctors and nurses
to end up with violence [1]:
working in the emergency room are practicing Taekwondo when they are off the duty. Some
(1) behavior marked by anger, agitation, hostility, tension, suspiciousness, excitement, stress
hospitals called for other measures including
(2) poor therapeutic alliance
stationing well-trained, unarmed security staff
(3) Poor response to treatment
around the clock to deter violent behavior.
(4) access/possession of firearms/other weapons
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 and thus reducing the
(5) acute symptoms of mania, schizophrenia, psychosis, delirium (6) low socioeconomic status (which often increases the frustration patients encounter daily)
risk of assaults and conflicts. Empathy is a magic
(7) low intelligence quotient
word paving the shortest path among people, and
(8) single (or less connected to society than
this is supposed to be the one that doctors by all means remember since they took the Hippocratic Oath.
normal) (9) intoxication (slurred speech, unsteady gait, flushed face, dilated pupils, etc.)
124
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
for loss of control
Suggested Dos and Don'ts
(2) See “edgy” patients late in the day when few
Do (1) Be alert to signs of tension in the patient’s behavior; e.g., motoric
others are around (3) Try to take a weapon from a patient (unless
restlessness, pacing,
clenching fists
there is no alternative); ask the patient to put it down. What will the future be like? Right now we
(2) See if patient can receive feedback that he/she seems tense and can calm him/herself (3) Inform colleagues or other staff if you plan
cannot give the answer. But we can only hope for the best.
to see a high-risk patient (4) Participate in continuing education activities
Reference
to develop skills in managing potentially violent interactions with patients
1.
Strategies for reducing the risk of patient violence toward
(5) Consult with a colleague or someone with
clinicians, American Psychological Association Advisory
expertise in managing violent patients when you
Committee on Colleague Assistance and Division 12,
have a higher-risk patient.
Section 7; Canadian Family Physician Vol.41: November
Don’t (1) Get isolated with a patient who seems at risk
1995 (Editor XU Jia)
JOURNAL OF MEDICAL COLLEGES OF PLA www.elsevier.com/locate/jmcpla
An epidemic of violence on medical personnel: are we prepared ZHANG Han1, ZHANG Yan2* 1
The Five-year Program on Clinical Medicine, Second Military Medical University, Shanghai 200433, China 2
Department of Foreign Languages, Second Military Medical University, Shanghai 200433, China Received December 21, 2012; accepted January 14, 2013
Abstract The incidence of violence against doctors has been increasing, both in China and worldwide. Very often we hear doctors being molested, thrashed and abused by lay public for a trivial medical malpractice or even no fault of theirs. The once glittering halo of medical workers is being shredded thanks to the stressed health system and a lack of evaluation for risk of violence of the patients. Modern China sees a wide disparity between industry standards in rural and urban areas. Peo ple seeking health care service are often scared, can’t get timely service and turn their anger towards those around them. To change a whole system in this giant nation is too hard a rock. Therefore, our focus is on the prompt awareness and preparation of a possible patient violence. The simplest approaches seem to be the most effective. Medical staffs should re-learn empathy on patients and be better trained on recognizing and reducing conflicts.
Keywords: Patient violence and assaults; Prevalence of aggression; Health care industry; Risk factor evaluation; Patient empathy
*
Corresponding author.
E-mail address: [email protected] (ZHANG Y.)
121
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
Being a doctor in China is by no means easy, 1. Introduction
and to some extent even dangerous. A national survey has indicated that the year of 2006 witnessed
Once upon a time, doctors were under their
9 831 disputes hurt 5519 medical personnel. In the
little halos. Thankful faces, grateful tears and
year 2007, 73.3% of the hospitals in mainland China
inspiring words, are those lightening the glitters of
have seen violence, threatening, abusive assault
the halos. Everything has changed. These years have
medical personnel; 59.6% of hospital patients were
witnessed a great depression, not economically, but
found dissatisfied with the treatment result, they
the status of the doctors. Health-care settings have
gathered at the hospital and became great threats to
been traditionally thought of as “safe havens”,
hospital staffs and other patients. Very often we hear
opening to anyone as a place to be protected and
doctors being molested, thrashed and abused by lay
cared for. Who would have foreseen a mounted
public for a trivial medical malpractice or even no
epidemic on medical personnel. Health-care staffs
fault of theirs. Thousands of medical staffs have been
are now victims of threat, violence and abuse,
victimized under their own patients. Some doctors
hospitals turned into battlegrounds and patients, who
described their lives as: Disease, Drug, Drink
are supposed to be saved from hurt, become mobs.
(alcohol), Divorce. Things need to be changed
Violence as a way of achieving justice is both
urgently.
impractical and immoral. Man cannot blame all those burst into violence because it is a natural gift given to us and a normal
2.2. A tragedy happened in October 2011 may partly annotate the vicious cycle
reaction to fear as a human being. What on earth unfortunately gives birth to violence is fear, which is
A calligrapher sued Beijing Tongren Hospital in
the root of the violence cycle. Sadness, anger, self
court for medical malpractice and stated that the
destruction and suffering, these are the four steps
hospital fabricated his medical records. Because of a
leading to violence.
laryngeal carcinoma that has locally metastasized, he was
2. Medical treatment disputes in China
admitted
to
the
otorhinolaryngological
department. Considering the mass spread, the surgeon cut off his vocal cord during the tumor
2.1. Medical treatment disputes in China increase at
resection with the preoperative consent of the patient.
a speed of 23% annually since 2002
Knowing the permanent loss of the ability to phonate,
122
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
he was at first under the shadow of sadness for not
follows consequently, as physicians are pressured to
being able to talk any more, then he got angry with
see more patients in shorter amounts of time.
himself, the surgeon, nurses, and everyone around
Patients are rightly frustrated, and some are lashing
him. “I became a dumb and disabled loser from a
out. China, as a special country with 80 percent of its
talkative and knowledgeable artist”, he wrote, “I just
population living in rural areas, the situation is
wanted revenge every day”, the China Youth Daily
bound to be even worse. A migrant worker in
reported. Finally he made his decision that it is the
Chaozhou, Guangdong province, stabbed one doctor
surgeon who should shoulder every outcome. This
to death and seriously injured two other hospital
trustful surgeon, as well as a kind woman was
personnel on 3 November, which renewed the debate
stabbed so severely on her arm that it was unclear
on strained doctor-patient relations.
whether she would be able to hold the scalpel again.
people rush into the metropolises for the sake of a
She was not out of danger until a nine-hour operation,
better treatment and the treatment ends up to be way
and was moved into intensive care.
below their expectance, this story would possibly
Once these
end as a tragedy: They might have staked all their 3. Violence is a symptom of health care
fortunate and even their credit and reputation, it has
dysfunction
to be a happy ending, otherwise, they have nothing left.
The uncomfortable truth in China has always been the giant population and the huge gap between
4. Patient violence is a global issue
the rich and the poor versus the nationwide insufficient health care. Modern China sees a wide
It is unfair to say that patient violence is a
disparity between industry standards in rural and
regional problem; and the grey cloud is now
urban areas, and the extremely low doctor-patient
worldwide, even in some of the most developed
ratio in the villages has made seeking medical care in
countries. In the US, according to a Bureau of Labor
the metropolises a trend and a must. In some rural
Statistics analysis published last year, almost 60% of
areas of China, there is only 0.47 doctor among 1000
assaults in the workplace occurred in a health care
people, that is to say, over 1200 citizens would have
setting. A survey from the British National Audit
on average one doctor. In European countries like
Office (2003) stated that violence and aggression
Germany
3.3.
accounted for 40% of reported health & safety
Deterioration of the doctor-patient relationship
incidents amongst healthcare workers (Oostrom and
and
France,
the
ratio
over
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
Mierlo 2008). Three-quarters of Canadian family
123
5. Advices that help
doctors say they suffered at least one incident of major abuse at the hands of a patient, according to a
Education and training in the evaluation and
new study. Australian medical association Victoria
management of potentially violent patients is often
vice-president said every emergency doctor would
minimal. Because of the complexity of such patients
have stories of violence, including in some cases
and the high intensity of the context in which they
being punched, kicked, scratched and threatened
can present, it is helpful to be prepared with
with knives or furniture.
knowledge and some plans for dealing with this
The simplest approaches would most likely be the most effective.
situation. An evaluation for risk of violence is needed at
The world-wide doctor-patient disputes did
the first contact with the patient, when violent
bring about some changes. Health-care orgnizations
thoughts are reported, and when there are pertinent
are busy taking actions to better protect their staffs.
clinical or behavioral changes. If a patient appears
To learn martial arts would be one way that makes
with some of these characters, he or she is more like
some sense. In Australia, some doctors and nurses
to end up with violence [1]:
working in the emergency room are practicing Taekwondo when they are off the duty. Some
(1) behavior marked by anger, agitation, hostility, tension, suspiciousness, excitement, stress
hospitals called for other measures including
(2) poor therapeutic alliance
stationing well-trained, unarmed security staff
(3) Poor response to treatment
around the clock to deter violent behavior.
(4) access/possession of firearms/other weapons
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 and thus reducing the
(5) acute symptoms of mania, schizophrenia, psychosis, delirium (6) low socioeconomic status (which often increases the frustration patients encounter daily)
risk of assaults and conflicts. Empathy is a magic
(7) low intelligence quotient
word paving the shortest path among people, and
(8) single (or less connected to society than
this is supposed to be the one that doctors by all means remember since they took the Hippocratic Oath.
normal) (9) intoxication (slurred speech, unsteady gait, flushed face, dilated pupils, etc.)
124
ZHANG Han et al./ Journal of Medical Colleges of PLA 28(2013)120-124
for loss of control
Suggested Dos and Don'ts
(2) See “edgy” patients late in the day when few
Do (1) Be alert to signs of tension in the patient’s behavior; e.g., motoric
others are around (3) Try to take a weapon from a patient (unless
restlessness, pacing,
clenching fists
there is no alternative); ask the patient to put it down. What will the future be like? Right now we
(2) See if patient can receive feedback that he/she seems tense and can calm him/herself (3) Inform colleagues or other staff if you plan
cannot give the answer. But we can only hope for the best.
to see a high-risk patient (4) Participate in continuing education activities
Reference
to develop skills in managing potentially violent interactions with patients
1.
Strategies for reducing the risk of patient violence toward
(5) Consult with a colleague or someone with
clinicians, American Psychological Association Advisory
expertise in managing violent patients when you
Committee on Colleague Assistance and Division 12,
have a higher-risk patient.
Section 7; Canadian Family Physician Vol.41: November
Don’t (1) Get isolated with a patient who seems at risk
1995 (Editor XU Jia)