Violence against doctors: a medical(ised) problem? The case of National Health Service general practitioners

Abstract

Violence against doctors provides an illuminating context for studying medicalisation and its limits in the management of deviance. The paper examines the emergence of such violence as a policy issue in England, with particular reference to general practitioners (GPs) in the National Health Service. Recent guidance exhorts doctors to exercise 'zero tolerance' with respect to acts of violence. The emphasis is on risk management and protecting victims rather than on resolving the perpetrators' problems. The paper argues that this policy frame is consistent with recent claims from criminologists that there is a new 'turn' in penal policy, away from rehabilitation and addressing the needs of individual offenders. However, responses of individual GPs, obtained through a postal questionnaire sent to c.1000 GPs and in-depth interviews with a sub-sample, suggest that doctors are not 'zero tolerant' in responding to attacks. But nor are they medical imperialists seeking to include all perpetrators within their professional jurisdiction. Rather, they exercise professional discretion about behaviours which often fall into a 'grey area' between 'illness' and 'crime', and about individuals who are not clearly categorisable as either 'sick' or 'bad'.

Receptionists' experiences of occupational violence in general practice: a qualitative study

“…12 The preponderance of verbal violence and the low perceived frequency of physical violence are in keeping with previous studies, both in GPs, 6,10,15,17,21,22 and receptionists. 11,12 Responders' attributions of violence to poverty, unemployment, drug use, and high prevalence of mental illness were consistent with previous empirical studies that have identified socioeconomic status, 6,12 illicit drug use, 6 and mental illness, 6 as associations of patient violence.…”

“…12 By far the most prevalent form of violence in these studies was verbal abuse 11,12 (as it has been in studies of GP violence from the UK, 5,[14][15][16] and Australia 6,17 ). Despite being predominantly verbal abuse or other 'low level' violence, 6 previous studies, 6,9,10 have suggested occupational violence has a considerable effect on GPs' practice and on their mental health. The experience of GP staff regarding this significant issue is less clear.…”

“…9,10 But these latter findings are based on reports of GPs, not on those of the receptionists themselves.…”

The response of general practitioners to the threat of violence in their practices: results from a qualitative study

“…2 Quantitative research, mainly questionnaire studies from the UK, have established a relatively high prevalence of violence in the work experiences of GPs. [3][4][5][6] Qualitative research has the potential to further elucidate the effect of work-based violence on GPs and their medical practice. Though qualitative research in this area is sparse, it has been demonstrated that British GPs display a complex set of responses to experiences of violence in their practice and these often do not conform to 'zero tolerance' policies.…”

El estudio de los procesos de medicalización en América Latina

“…As a result, various opposing views are emerging about its future. According to some, medicalization has already started revealing its limits and there are signs pointing to a progressive demedicalization of many phenomena (Elston et al, 2002). In Latin America, however, the one-directional vision of the process, predicting its expansion, still prevails.…”