Statistics suggest that a third of doctors will experience some form of violence in their workplace. As part of the 2002 NHS Plan the government sought to tackle violence in GP surgeries through involvement of the PCTs in their Zero Tolerance campaign.
Despite statistics from the DoH that suggest violent attacks have fallen by 1,690 in 2005/6, we cannot afford to be complacent about this very real threat. As part of the GMS contract, practices may offer to see violent patients on behalf of other surgeries as part of a direct enhanced service.
Staying safe in the surgery
Before you start seeing patients, look around your consulting room and make a risk assessment.
Examine the layout of the room. Seat yourself closer to the door than the patient so you can get out if you need to. Consider if there is anything in the room that could be used as a weapon. Move sharp items out of sight and don't place hot liquids between you and the patient.
It is important to ask where the panic alarms are in each room. These may be actual buttons or linked in with the computer system. Thankfully, in most surgeries these are not used very often. This may mean that the staff forget to tell you of their existence unless you specifically ask.
Signs of possible violence
Patients, or their relatives, may become violent for a multitude of reasons. They may be angry at being kept waiting, annoyed by the attitude of staff or upset about a clinical error. Very often you will start to have a sense that the consultation is not going well before overt signs appear.
The patient may start to avoid your gaze, interrupt you, swear or raise their voice. They may start to use intimidating gestures, such as pointing or thumping their fist on the desk. They may stand too close to you, raise their fists, pace the room or start to throw objects around while making verbal threats.
Keeping in control
Violence is an escalating process, so the key is to spot the early signs of possible danger and deal with them.
With an angry patient or relative, give them time to vent their feelings. Acknowledge their anger but don't antagonise them by telling them that you understand how they feel. Speak in a calm reassuring tone and try not to be defensive or argue back.
Use open body language and look at the patient's face. Find out exactly why they are angry and how they would like the matter resolved.
Resist the urge to blame other members of staff if you realise that you are not in the wrong and don't make comments about third party conversations unless you know exactly what was said.
Once you have established the problem, discuss possible solutions with the patient and how these will be resolved. Strongly encourage them to put their complaint in writing.
If you feel that the patient may be physically violent, it is best to leave the room as quickly as possible. Try not to antagonise the patient by making sudden moves. If your way out of the room is blocked, activate the panic alarm, shout for help or try to talk calmly to the patient, attempting to defuse the situation.
Conflict resolution courses are excellent for providing advice on how to do this. Courses also teach techniques to deflect common assaults safely.
Check the practice policy for dealing with certain groups of patients where your personal safety could be at risk. Examples of such patients include drug abusers trying to obtain more supplies of a particular medication, or patients with a previous history of violence.
Safety on home visits
Home visits may present dangers, especially when visiting new patients. Let staff know where you are going and when you are likely to return.
Take a fully charged mobile phone with you and let the surgery have the number.
If you are unsure about visiting, don't go alone. You might want to have a pre-arranged phrase you could use when calling the surgery to indicate that you are in difficulty (for example, 'can I speak to Barbara Davies please?'). This will alert staff without arousing suspicion.
When entering a house always have the relative lead you up to the patient, especially when going upstairs. This makes it more difficult if someone is planning to ambush you.
Try to minimise your appearance as a target. Think very carefully if it is appropriate in some areas to carry your equipment in a typical doctor's bag and weigh up the pros and cons of carrying controlled drugs in your bag if you are not likely to need them.
If you are a woman, dressing modestly may help deflect unwanted male attention.
- Dr Croton is a salaried GP in Birmingham
- This topic falls under section 1 of the GP curriculum 'Being a General Practitioner', www.RCGP-curriculum.org.uk
- Contact Emma Quigley at GP Education on (020) 8267 4805 or email GPeducation@haymarket.com
Learning Points
1. Consider the layout of your room and keep any potentially dangerous items out of sight.
2. Know where the panic alarms are in each room.
3. Recognise aggressive behaviour and learn how to defuse potentially violent situations.
4. When attending home visits take a mobile phone and ensure the practice staff know where you are going.
5. Consider attending a conflict resolution course.
Resources
Breakaway courses: www.basistraining.co.uk/BreakAwaySelfDefence.htm.
