Remedy needed for GP attacks

Shocking level of violence against staff continues, says Dean Marshall.

LAST year, a GP was beaten up by a patient in his consulting room. In the summer, another GP was stabbed by a patient in her practice. These are just two horrific examples of violence towards doctors, and, depressingly, they are not isolated incidents.

Unfortunately, due to the nature of the work undertaken by doctors, many have come to accept that the risk of violence in their working environment is part of the job. There are, of course, instances where violent behaviour is caused by illness.

However, an increasing proportion of incidents are caused by frustration or anger and inflamed by drugs or alcohol.

In general practice, doctors often know the perpetrator of the incident personally. Frequently they are a patient or a patient's relative and this can make the situation even more difficult to deal with.

Violence can often be the result of personal problems or caused by dissatisfaction with the service a patient receives, but it is never excusable.

In Scotland in 2005, 23,752 violent incidents against healthcare workers were reported and in the Lothian region alone, 9000 incidents took place in primary care. But this is just the tip of the iceberg as many cases go unreported.

Research carried out by the British Medical Association found that more than a third of doctors surveyed experienced some form of violence in the work place in the previous year, yet only one third reported it.

The most common forms of verbal abuse include abusive language, verbal threats, racial comments and personal intimidation. Physical assaults were reported by almost a quarter of doctors, including being pushed, shoved, hit or punched and threatened with weapons.

These statistics paint an appalling picture of an increasingly turbulent society where violence is commonplace.

In 2005, the Scottish Executive introduced the Emergency Workers Act. This piece of legislation sent a powerful message to those individuals who thought it was acceptable to assault a doctor, a paramedic or a fireman. It brought into force tougher penalties for these crimes and made them easier to prosecute.

While this legislation represented real progress in our efforts to reduce the number of attacks on health workers, it was incomplete. The Act failed to include those health professionals who are most vulnerable and most at risk – those health professionals who work, often alone, in the community, in GP surgeries, and in patients' homes.

It is therefore tremendously encouraging that Public Health Minister Shona Robison has announced the Government's intention to extend the Act to include all health workers, including those who work in the community.

While this will not end all violence against healthcare workers, it will restore the balance and create equality amongst all health professionals.

It continues to send out the same strong message that violence against any healthcare worker will not be tolerated and will not go unpunished.

Extending this legislation is just one way to protect health workers from violence. However, staff who have experienced violence or the threat of violence must be supported.

When incidents are reported they must be followed up by the appropriate action and counselling. This is because the mental effects are often more long-lasting than physical injuries alone.

I know of one GP who has been left with lasting problems after he visited a patient at home and, without any warning, was headbutted. This was a man accustomed to suffering verbal abuse from his patients but had never been physically assaulted.

His injuries amounted to painful cuts and bruises but, once these wounds healed, he discovered psychological scars remained – he is now more anxious at work, suffers from flashbacks and has trouble sleeping.

Training on managing potentially- violent situations should be available across the NHS. It is also important to raise patients' awareness of their responsibilities and what is acceptable behaviour.

Only then will we be able to reduce the number of violent incidents against health workers who dedicate their careers to looking after their patients.

• Dr Dean Marshall is a GP in Midlothian and chairman of the British Medical Association's Scottish General Practitioners Committee