Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study

BMC Health Services Research Verbal and physical violence towards hospital- and community-based physicians in the Negev: an observational study Tal Carmi-Iluz 1 Roni Peleg 0 1 Tami Freud 0 Pesach Shvartzman 0 1 0 Sial Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel 1 The Department of the Family Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel Background: Over recent years there has been an increasing prevalence of verbal and physical violence in Israel, including in the work place. Physicians are exposed to violence in hospitals and in the community. The objective was to characterize acts of verbal and physical violence towards hospital- and community-based physicians. Methods: A convenience sample of physicians working in the hospital and community completed an anonymous questionnaire about their experience with violence. Data collection took place between November 2001 and July 2002. One hundred seventy seven physicians participated in the study, 95 from the hospital and 82 from community clinics. The community sample included general physicians, pediatricians, specialists and residents. Results: Ninety-nine physicians (56%) reported at least one act of verbal violence and 16 physicians (9%) reported exposure to at least one act of physical violence during the previous year. Fifty-one hospital physicians (53.7%) were exposed to verbal violence and 9 (9.5%) to physical violence. Forty-eight community physicians (58.5%) were exposed to verbal violence and 7 (8.5%) to physical violence. Seventeen community physicians (36.2%) compared to eleven hospital physicians (17.2%) said that the violence had a negative impact on their family and on their quality of life (p < 0.05). The most common causes of violence were long waiting time (46.2%), dissatisfaction with treatment (15.4%), and disagreement with the physician (10.3%). Conclusion: Verbal and/or physical violence against physicians is common in both the hospital and in community clinics. The impatience that accompanies waiting times may have a cultural element. Shortening waiting times and providing more information to patients and families could reduce the rate of violence, but a cultural change may also be required. - Background Over recent years Israel, as well as other countries, has witnessed an increase in the prevalence of acts of violence. This rise is seen in workplaces, in recreation sites, on the roads, within the family and even in schools. The mass media are full of reports on violent acts. Violence does not necessarily involve physical contact; it can be verbal or mental. Sometimes psychological or verbal abuse has more severe consequences than acts of physical violence. Health service providers in hospitals and community clinics are often exposed to verbal and even physical violence that can engender frustration and despair [1-10]. Violent acts against workers have been defined as "any event that the worker is threatened or attacked by another person due to his job" [3,9]. Many physicians feel threatened by verbal and physical violence at work [4,9]. Physicians in emergency medicine, psychiatrists and primary care physicians are at increased risk of violent acts from patients and families [3,4,10]. Studies from England from 1989, 1991, and 1997 have shown that verbal abuse is the most frequent type of violence reported by British physicians (2591%) [5-7] compared to physical violence (111%). However the latter has significantly affected those physicians who were exposed to it leading in some cases to depression, insomnia, post-traumatic stress disorder, agoraphobia [4] and even a level of fear and/or anxiety that can cause work absenteeism [8] In the US the rate of violence is even higher. Between the years 19801990, 106 healthcare workers died as a result of violence: 27 pharmacists, 26 physicians, and 53 nurses [2]. Another survey of 170 university hospitals in the US showed that 57% of all emergency room employees had been threatened by weapons over the five-year period prior to the survey [10]. Seventy percent of the physicians and 90% of the support staff working in a hospital emergency room in Israel reported violent acts, mostly verbal abuse [1]. The main reasons for these outbursts were long waiting times, dissatisfaction with treatment, something that was said that the patient took exception to, and in some cases the influence of alcohol and/or drugs on the perpetrator of the violence [1]. No other studies of this type have been reported from Israel. The aim of the present study was to assess violence against physicians in the southern Negev region of Israel, and to compare rates in the hospital with those in community clinics. Methods Setting The study was conducted within the framework of the Southern District of Clalit Health Services, Israel's largest HMO that serves about 60% of the population. The population of the Negev region in southern Israel numbers about 530,000, most of a low to middle socioeconomic level. The largest city in the area is Beer-Sheva with about 200, 000 residents. The Soroka University Medical Center is located in Beer-Sheva. The rest of the Negev's residents live in smaller communities. The study was conducted among 95 physicians in all major departments of the Soroka Medical Center (internal medicine, surgery and pediatrics) and 82 family physicians and pediatricians working in primary care clinics of the Clalit Health Services in the Negev. Hospital physicians were sampled based on the physician roster of the Soroka University Medical Center and the communitybased physicians based on the physician roster of the Southern District of the Clalit Health Services. In the few cases in which the physicians stated that they work both at the hospital and in the community, their primary place of work was used for statistical analyses. The study instrument All participants completed an anonymous questionnaire, consisting of 36 items, on their experiences with and attitudes towards violence. The questionnaire included demographic and personal data, reports on exposure to verbal and physical abuse over the previous year, information about how they dealt with the violence and their attitude to it. Most of the items were multiple-choice questions, with one possible answer, but in a small number of questions we used an open format. An example of a closed question is: How did you react to an episode of verbal violence? The response options were: 1) I ignored it; 2) I made a verbal response; 3) I called for security personnel; 4) I called the police; 5) I lodged a complaint with the police; 6) other (with space to write a detailed response). We developed the questionnaire specifically for the study after a thorough review of the literature on the subject. The questionnaire was revised in light of the results of a pilot study of 15 ph (...truncated)