Protecting yourself on the job: How GPs can avoid violence from patients

In the wake of this week’s successful legal appeal by two women who assaulted a paramedic and another alleged assault on a paramedic in Melbourne, doctors are talking about what more can be done to protect healthcare professionals.
 
It has been estimated that almost two-thirds of GPs have experienced a form of violence at the hands of a patient over the preceding 12 months. The most prevalent type of violence is verbal and written aggression, followed by property damage, sexual harassment/assault, physical violence and stalking.
 
RACGP Victoria Chair Dr Cameron Loy has been physically assaulted on the job multiple times – once very badly.
 
‘Violence does occur in our job, and it’s awful. We’ve seen GPs murdered or really badly injured. It’s horrendous,’ he told newsGP. ‘Perpetrators need to be dealt with to the full extent of the law.’
 
Dr Loy believes proposed answers like duress alarms are only part of the solution.
 
‘Duress alarms don’t really help you. Thinking a button will save you is dangerous,’ he said. ‘I’ve worked in prisons and by the time security came after pressing a button, it would be too late.’
 
Dr Loy said it is important that GPs acquire the skills to sense potential danger, and learn techniques to best manage patient who may be violent.
 
‘It’s much, much better to have the situational awareness, to know what’s going on, to have de-escalation techniques, to listen to your gut – and to act on it,’ he said.
 
Dr Annette Carruthers has previously told the RACGP that negotiating and defusing techniques are a vital strategy.
 
‘When dealing with any patient it is important to interact with them respectfully, in a way that you would like to be treated yourself. This can reduce the potential for anger and aggression,’ she said.
 
‘For example, if you have a drug-seeking patient you then have to politely but firmly say “no”. Stick to your own framework about when and under what circumstances you would supply Schedule 8 drugs or benzodiazepines.’
 
The RACGP has a guide for preventing patient violence, which covers risk identification, de-escalation techniques, care team preparation, improving clinic site design, etc.
 
The guide, General practice – A safe place: A guide for the prevention and management of patient-initiated violence, states that there are several factors likely to increase risk of violence from patients.
 
Younger or less experienced GPs are at higher risk of violence overall, while female GPs are at higher risk of sexual harassment and assault. International medical graduates (IMGs) are also more vulnerable to patient-initiated violence.
 
It is also riskier to work outside of normal business hours. Closing time for a practice is also associated with elevated risk. 

While Victoria introduced mandatory jail sentences for people convicted of assaulting healthcare professionals in 2014, ‘special circumstances’ are available to the courts that allow people to avoid prison time. Following the recent incidents, State Opposition Leader Matthew Guy has said he plans to introduce a private member’s bill to ensure people who attack paramedics stay in prison.

Queensland also introduced harsher jail terms in 2014 for similar offences against healthcare professionals.

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