Curbside Consultation

Violence in the Health Care Setting: What Can We Do?


Am Fam Physician. 2018 Sep 15;98(6):381-382.

  See related article in FPM: How to Prepare for and Survive a Violent Patient Encounter

Case Scenario

I have been the family physician for a middle-aged man for several years; we have had multiple visits over those years. During our encounters, he has always been polite, modest, and kind. Months ago, I discovered that he has been rude and demeaning to my medical assistant. This behavior has occurred on multiple occasions, on the phone and in person.

I feel guilty because when I see him, he is servile and mild-mannered. I want to ask him why he acts differently with other members of his care team, but I have not found the courage to confront him.

I am not sure whether it is professional or ethical for me to address his behavior with him, but I think I need to take action to ensure the well-being and safety of my staff. Because of his aggressive language and current news that is filled with acts of violence, I am concerned that his behavior might escalate.


In July 2017, Dr. Todd Graham was fatally shot by his patient's husband when Dr. Graham denied his patient's request for opioids.1 This case highlights that, according to the Bureau of Labor Statistics, health care professions are one of the most dangerous industries of employment in the United States.2 Dr. Graham became a victim of the most common type of health care–associated violence: patients, or their families or friends, against health care professionals.3 Nurses, who comprise a field that is predominantly staffed by women, are most often the target of this violence.4 The acts of violence include verbal aggression, threats of bodily harm, and even death. In addition to physical injury, violence can cause psychological harm, including insomnia, depression, and posttraumatic stress disorder3; witnessing the aftermath of violence has the potential to provoke a variety of psychiatric conditions in first responders.5

Although violent tendencies are often present in patients with underlying risk factors (e.g., substance abuse, psychiatric illness, delirium, criminal history, delusions), individuals

Author disclosure: No relevant financial affiliations.

Address correspondence to Bonnie Huang Hall, MD, PhD, at Reprints are not available from the author.


show all references

1. Phillips K. A doctor was killed for refusing to prescribe opioids, authorities say. The Washington Post. July 29, 2017. Accessed June 29, 2018....

2. Bureau of Labor Statistics. News release: nonfatal occupational injuries and illnesses requiring days away from work, 2015. USDL-16-2130. Accessed June 25, 2018.

3. Phillips JP. Workplace violence against health care workers in the United States. N Engl J Med. 2016;374(17):1661–1669.

4. Morrison JL, Lantos JD, Levinson W. Aggression and violence directed toward physicians. J Gen Intern Med. 1998;13(8):556–561.

5. Shultz JM, Thoresen S, Galea S. The Las Vegas shootings—underscoring key features of the firearm epidemic. JAMA. 2017;318(18):1753–1754.

6. Friedman RA. Violence and mental illness—how strong is the link? N Engl J Med. 2006;355(20):2064–2066.

7. Occupational Safety and Health Administration. Guidelines for preventing workplace violence for health-care and social service workers. U.S. Department of Labor, OSHA 3148-06R, 2016. Accessed June 25, 2018.

8. Boxerbaum E, Burdett R, Charron J, et al. Managing disruptive behavior and workplace violence in healthcare. ASIS International Healthcare Security Counsel, December 2010. Accessed June 25, 2018.

9. Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health. Occupational violence: workplace violence prevention for nurses. CDC course no. WB2908—NIOSH pub. no. 2013-155. Accessed June 25, 2018.

10. Chipidza F, Wallwork RS, Adams TN, Stern TA. Evaluation and treatment of the angry patient. Prim Care Companion CNS Disord. 2016;18(3).

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.

A collection of Curbside Consultation published in AFP is available at

Please send scenarios to Caroline Wellbery, MD, at Materials are edited to retain confidentiality.



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