Hi everyone, Please read this column by Dr. Helen Ouyang, an ER physician in New York and a professor at Columbia University. The piece is entitled "Stabbed. Kicked. Spit On. Violence in American Hospitals Is Out of Control,” and it appears in The New York Times.
It's not just in the ER. On a recent visit to the hospital lab, I thanked the phlebotomist for masking (few do now), and heard from her a sad tale of how often she has been berated, called "sheep" and worse. But she believes the science, knows she is dealing with patients who are often immunocompromised, often unmasked (sometimes both!), and continues to mask, even with little support from her co-workers. There are now more masks seen on visitors and patients than on staff, despite rising numbers locally (my town's school in western Massachusetts closed last week because so many kids, both in school and at home, had covid).
Viewed from a detached, psychological standpoint, I can say we shouldn't be surprised by what you're reporting here. Patients in ER's are often under significant stress and so become more unreasonable/emotional than they already tend to be. And of course the emotional temperature of our society has risen in the last few years. That said, I had no idea that this was such a serious issue, and my heart goes out to ER docs and nurses, who are already under stress in "normal" work circumstances.
Yes, and I trust that my brief explanation was not construed by anyone here as an indication that I found the situation to be anything less than completely *un*acceptable. Indeed, it seems to me that new security measures of some kind need to be implemented in ER's to prevent (to the extent possible) these violent incidents.
Although it is impossible to avoid all physical attacks by agitated, aggressive, and disgruntled individuals in care and others, there are ways to mitigate violence directed at healthcare workers. This would be a valuable issue to address.
One issue that I've heard about: a healthcare worker gets attacked and their employer's response is to ask them how they might have prevented it (ie., blaming the victim!)
When this happens, the least we can do is be extremely supportive to our colleagues.
The link only opened the preview for me (could be because I suspended my NYT subscription), removing "?searchResultPosition=1" from the hyperlink opened it up, but anyone else having an issue can use the archive link: https://archive.ph/S5yGh#selection-821.24-821.170
Surprised at this: "This year Virginia became the first state to pass a law requiring that all emergency departments keep a security officer on site around the clock"
I naively thought every ER has security in place.
I did wonder how this compared to the past, so was pleased the authors cited a study showing a steady relative increase 2011-2018 (I assume a large jump 2020-2021 will be found before receding closer to pre-Covid levels).
My theories on the cause of increase (I'm temporizing):
- Higher percentage of patients coming in with drug or mental issues (seems like low hanging fruit explanation)
- Fewer PCP means more people may be heading to the ER than in the past adding to the overcrowding
- Shift to far more physicians being female may mean patients who may have "bit their tongue" in the past to a male doctor, now feel they can berate a woman? (The article almost says this without saying this). Could see this going the other way though, many men, even belligerent assholes, still abide by some code where they may more likely be a fuckwad to a male doc. I don't know.
- Rise in older population (combination of aging boomers and advancements in medicine). I only thought of this once I read the embedded report (https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm) - while hospitals have 10.4 injuries per 10,000 employees, nursing homes have 21.1)
More complicated hypothesis, and this is based on what I have seen out here in Cleveland the last 20 years:
We have seen a transformation of healthcare for decades where small independent hospitals are being absorbed into large networks. A report in 2018 notes "From 2013 to 2017, nearly 1 in 5 of the nation's 5,500-plus hospitals were acquired or merged with another hospital" [1] and this reflects what I have seen.
When a group purchases several hospitals, the accountants and efficiency engineers (*raises hand sheepishly*) often find ways to reduce redundancy, and that can mean buying 10 hospitals and closing 3 of them, reasoning that there was excess capacity. It may look good on a spreadsheet in a boardroom, but the downstream effect can be patients clogging up 7 ERs instead of 10, traveling further, adding to frustration, not to mention a new layer of bureaucracy passed down from above to the ER docs in attempts to "standardize" and "optimize".
Maybe?
Be interested to see ideas on what can be done to solve this problem.
The patients have a sense that no matter what they do to us, we will still treat them. Which is almost universally true. So...it's hard to enforce any consequence (other than pressing charges...)
ED violence is nothing new and even portrayed on St. Elsewhere 50 years ago. It sad to see even more violence today. Wonder how much the Opioid crisis. I always make it a point to thanks the HCW and try to make their day.
Does anybody notice that the article focuses on Vermont emergency departments. This problem is decades old in urban areas but Burlington Vermont? Well Burlington is an urban center of 45000 people. Not much of a city is it. This behavior in the rest of Vermont much rarer in my (patient) experience. In Massachusetts next door as a doctor it’s been a problem for decades. So I’m not sure what has changed but the country does seem a bit coarser and less caring I guess.
It's not just in the ER. On a recent visit to the hospital lab, I thanked the phlebotomist for masking (few do now), and heard from her a sad tale of how often she has been berated, called "sheep" and worse. But she believes the science, knows she is dealing with patients who are often immunocompromised, often unmasked (sometimes both!), and continues to mask, even with little support from her co-workers. There are now more masks seen on visitors and patients than on staff, despite rising numbers locally (my town's school in western Massachusetts closed last week because so many kids, both in school and at home, had covid).
That is really depressing.
Viewed from a detached, psychological standpoint, I can say we shouldn't be surprised by what you're reporting here. Patients in ER's are often under significant stress and so become more unreasonable/emotional than they already tend to be. And of course the emotional temperature of our society has risen in the last few years. That said, I had no idea that this was such a serious issue, and my heart goes out to ER docs and nurses, who are already under stress in "normal" work circumstances.
It is definitely a symptom of something bad...but it's not acceptable
Yes, and I trust that my brief explanation was not construed by anyone here as an indication that I found the situation to be anything less than completely *un*acceptable. Indeed, it seems to me that new security measures of some kind need to be implemented in ER's to prevent (to the extent possible) these violent incidents.
100%
Although it is impossible to avoid all physical attacks by agitated, aggressive, and disgruntled individuals in care and others, there are ways to mitigate violence directed at healthcare workers. This would be a valuable issue to address.
One issue that I've heard about: a healthcare worker gets attacked and their employer's response is to ask them how they might have prevented it (ie., blaming the victim!)
When this happens, the least we can do is be extremely supportive to our colleagues.
Of course, that is inappropriate. On another note, in this day and age, Teachers are at even higher risk for directed violence.
The link only opened the preview for me (could be because I suspended my NYT subscription), removing "?searchResultPosition=1" from the hyperlink opened it up, but anyone else having an issue can use the archive link: https://archive.ph/S5yGh#selection-821.24-821.170
Surprised at this: "This year Virginia became the first state to pass a law requiring that all emergency departments keep a security officer on site around the clock"
I naively thought every ER has security in place.
I did wonder how this compared to the past, so was pleased the authors cited a study showing a steady relative increase 2011-2018 (I assume a large jump 2020-2021 will be found before receding closer to pre-Covid levels).
My theories on the cause of increase (I'm temporizing):
- Higher percentage of patients coming in with drug or mental issues (seems like low hanging fruit explanation)
- Fewer PCP means more people may be heading to the ER than in the past adding to the overcrowding
- Shift to far more physicians being female may mean patients who may have "bit their tongue" in the past to a male doctor, now feel they can berate a woman? (The article almost says this without saying this). Could see this going the other way though, many men, even belligerent assholes, still abide by some code where they may more likely be a fuckwad to a male doc. I don't know.
- Rise in older population (combination of aging boomers and advancements in medicine). I only thought of this once I read the embedded report (https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm) - while hospitals have 10.4 injuries per 10,000 employees, nursing homes have 21.1)
More complicated hypothesis, and this is based on what I have seen out here in Cleveland the last 20 years:
We have seen a transformation of healthcare for decades where small independent hospitals are being absorbed into large networks. A report in 2018 notes "From 2013 to 2017, nearly 1 in 5 of the nation's 5,500-plus hospitals were acquired or merged with another hospital" [1] and this reflects what I have seen.
When a group purchases several hospitals, the accountants and efficiency engineers (*raises hand sheepishly*) often find ways to reduce redundancy, and that can mean buying 10 hospitals and closing 3 of them, reasoning that there was excess capacity. It may look good on a spreadsheet in a boardroom, but the downstream effect can be patients clogging up 7 ERs instead of 10, traveling further, adding to frustration, not to mention a new layer of bureaucracy passed down from above to the ER docs in attempts to "standardize" and "optimize".
Maybe?
Be interested to see ideas on what can be done to solve this problem.
____________________
[1] https://www.usnews.com/news/healthiest-communities/articles/2018-07-23/what-happens-when-a-community-hospital-is-sold-to-a-large-corporation
your theories make sense to me
I’m deeply saddened and concerned to hear this. Judging by the comments, it doesn’t seem it will a priority to address this. Am I wrong?
The patients have a sense that no matter what they do to us, we will still treat them. Which is almost universally true. So...it's hard to enforce any consequence (other than pressing charges...)
I was thinking “preventative”. I am not very sure of the forms it could take.
ED violence is nothing new and even portrayed on St. Elsewhere 50 years ago. It sad to see even more violence today. Wonder how much the Opioid crisis. I always make it a point to thanks the HCW and try to make their day.
I think substance use has a role in this yes. The answer there is to treat them before they need an ER.
Does anybody notice that the article focuses on Vermont emergency departments. This problem is decades old in urban areas but Burlington Vermont? Well Burlington is an urban center of 45000 people. Not much of a city is it. This behavior in the rest of Vermont much rarer in my (patient) experience. In Massachusetts next door as a doctor it’s been a problem for decades. So I’m not sure what has changed but the country does seem a bit coarser and less caring I guess.
Yeah that's a good point. I do wonder if (as others said above) some of this reflects substance use disorder (which has reached these communities)...