Violence against physicians at work

Issue: BCMJ, vol. 59 , No. 4 , May 2017 , Pages 230 WorkSafeBC

WorkSafeBC defines violence as not only the actual or attempted use of physical force that causes injury, but also threatening statements or behaviors that cause a worker to believe they are at risk of injury.


WorkSafeBC defines violence as not only the actual or attempted use of physical force that causes injury, but also threatening statements or behaviors that cause a worker to believe they are at risk of injury.


Unfortunately, violence is one of the risks that come with working in health care. Physicians who work in environments where patients are more likely to react violently are at higher risk, but those who work in any type of practice or location are vulnerable.

Canadian Medical Association Journal article[1] notes that almost all primary care physicians experience abuse during their career. For acute care physicians, the risk continues to increase with the growing number of patients with mental health and substance abuse problems. The physical and emotional impact and longer-term sequelae are not well understood.

Doctors of BC and WorkSafeBC remind physicians that there are resources available and that physicians can take steps to help prevent or respond to violent incidents.

Steps you can take now

Training
Take advantage of training that includes tips for identifying at-risk situations, de-escalation techniques, and physical training for violent situations. Training should be tailored to physicians and preferably be CME-accredited. Some health authorities offer this training. To help limit risk, be aware of your patients’ history when possible. If you don’t know, ask.

WorkSafeBC insurance coverage
Ensure you have appropriate WorkSafeBC coverage, if applicable. Registration and personal protection information is available at http://worksafebc.com.

Doctors of BC insurance coverage
Protect yourself and your family with appropriate accident and disability insurance through Doctors of BC. Information is available in the members’ section of www.doctorsofbc.ca.

Steps to take after a violent incident occurs

Take care of yourself
Seek appropriate care in case of an injury. Refrain from self-treatment, and have a colleague examine or treat your injury. Once you are able, document all relevant information pertaining to the incident.

Report the incident
Report any violent incidents to your health authority, WorkSafeBC, or both. Physicians are among the least likely health professionals to report personal incidents of violence. Even if you do not expect to take time off work, you should document and report the incident to protect yourself in case of longer-term injuries and to ensure you receive the insurance benefits and income protection you’ve purchased. Reporting also helps track incidents and improve local policies and procedures.

Seek follow-up support
In some cases you may be impacted long after a serious incident occurs. If you think you need additional help, contact the Physician Health Program for confidential assistance through their 24-hour number at 1 800 663-6729, or visit www.physicianhealth.com.

Review the incident
All workplace health and safety incidents must be investigated following an assault. Ensure you and the appropriate other parties, such as colleagues, the health authority, and other staff, discuss the attack. Having such discussions to review policies and procedures ensures that future issues are prevented or anticipated as much as possible.

Resources
Violence against physicians is serious. Doctors of BC’s policy statement on preventing violence is available on the Doctors of BC website at www.doctorsofbc.ca/policy-statements/health-human-resources/preventing-violence-healthcare.

Employers in BC have an obligation to ensure the health and safety of all workers at a workplace. WorkSafeBC’s information on violence in the workplace can be found at www.worksafebc.com/en/health-safety/hazards-exposures/violence.

Doctors of BC and WorkSafeBC continue to develop educational resources and prevention strategies specific to physicians of the province. Updates and information on programs and other resources will be provided as they become available.
—Colin Jackson, MD, FRCSC
—Peter Rothfels, MD
Co-chairs, WorkSafeBC/Doctors of BC Liaison Committee

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This article is the opinion of WorkSafeBC and has not been peer reviewed by the BCMJ Editorial Board.


References

1.    Sibbald B. Workplace violence is not part of a doctor’s job. CMAJ 2017;189:E184.

Colin Jackson, MD, FRCSC, Peter Rothfels, MD. Violence against physicians at work. BCMJ, Vol. 59, No. 4, May, 2017, Page(s) 230 - WorkSafeBC.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

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