Resident Experience of Abuse and Harassment in Emergency Medicine: Ten Years Later

Violence against physicians in training. A Romanian perspective

“…For example Li et al found senior residents to be statistically more likely to encounter verbal abuse (93 vs 80%), verbal threats (83 vs 51%), physical threats (63 vs 38%), and physical attacks (41 vs 14%); the cause was deemed to be the fact that senior residents begin to take increased responsibility for patient's care, and the interaction with patients and their relatives also increases. 4 In Romania however the residents have limited responsibilities until finishing their residency, being dependent upon their supervisor in a similar fashion during all their residency training. Increased responsibilities are progressively given to residents in more advanced stages of their trainings but the final interaction with the patient and relatives is usually intermediated through the supervisor (that takes for example the final decision regarding the treatment option, necessary surgery, obtaining the informed consent, informing the patients or the relatives in case of a negative outcome, and so on).…”

“…For example, in a nationwide study regarding physical aggression against surgical trainees, Barlow found a total prevalence of 38% 15 ; Paola et al found a prevalence of 41% in internal medicine trainees 16 ; Coverdale reported a 39% rate in psychiatry postgraduates 12 ; and Li determined that 50% of the residents in emergency medicine suffered at least one physical trauma. 4 For psychological abuse and sexual harassment, percentages reached almost 90% in some studies, 12 with some emergency department (ED) teaching hospitals reporting at least one verbal threat per day. 17 Common sites for assaults were emergency rooms and psychiatric units, 18e23 but other places have been cited as being associated with a high aggression rate as well.…”

“…The physicians in training are more exposed to this phenomenon due to: a defective training in violence management, 36 inadequacies regarding the identification of violent and pre-violent acts and behaviors, 35 difficulties in directing their attention to the anxiety and fears aroused when dealing with a violent patient, 37 difficulties in identifying the needs of patients with violent behaviors, the misconception that residens must "suck it up" (abuse and harassment is considered part of the job), 4 difficulties in reporting harassment/abuse, or not knowing where to go to report it, 4 fear of reprisal, 4 misconception that nothing can be done to minimize this phenomenon. 4 Differences between the aggressive acts in different specialties depends mainly upon the particularities of the patients and their medical conditions 24 ; however there are other causes that may influence the frequency of violent behavior, amongst which are cited: alcohol drinking (increased aggressiveness), often present in the ER, type of institution (for example university clinics are significantly less exposed to physical aggression compared to general hospitals), 38 aggressive behaviors from the superiors that increase irritability and stress, and therefore diminish the capacity to interact with the patient, 38,39 the severity of the disease, 2 type of medical care, 27,40 type and nature of the contact with the patients 28,41 , 24 . In our study psychiatry trainees are also put at a high risk, especially by patients with acute disorders.…”

“…3 Li et al reported a cumulative percentage of 91% of residents that had suffered any kind of aggression. 4 If more experienced physicians "have an eye" for patients with aggressive behaviors, and are therefore more capable of avoiding violent acts, this is not the case for physicians in training. 5 Aggressive behaviors are known to vary depending upon the seniority of the residents; for example Li et al found senior residents to be more prone to verbal and physical aggressivity, the main reason being the fact that they begin to take increased responsibility for the patient's care.…”

“…5 Aggressive behaviors are known to vary depending upon the seniority of the residents; for example Li et al found senior residents to be more prone to verbal and physical aggressivity, the main reason being the fact that they begin to take increased responsibility for the patient's care. 4 The outcomes of aggression are numerous and with potentially severe consequences for the trainee (decreased self-esteem, diminished working capacity, physical injuries from mild to disfigurement, or even death, absenteeism, changes in the workplace, and so on), the perpetrator (avoidance by other health-care workers, legal consequences, physical restraints), other patients (fear of patients may lead to mistakes, especially in early stage trainees), and the employer (lawsuits, loss of productivity owing to absenteeism or decreased efficiency). 6 As shown above, previous studies revealed a high variability regarding the types of aggressive acts against physicians depending upon specialty, year of study, geographical location, sex, causes, what constitutes violence and what not as seen by the physicians, and so on.…”