How to spot workplace violence before it happens — and how to respond if it occurs

Physicians must be prepared for the possibility that they will face violence on the job. In fact, health care workers are among the professionals most at risk for being assaulted in the workplace, according to the U.S. Department of Labor’s Occupational Safety and Health Administration.¹

Here are some things physicians can watch out for to spot potential violent behavior before it happens:

• Depressed moods,
• Changes in personality,
• Unusual, odd, or bizarre behavior, including clenched fists, excess sweating, or altered breathing,
• Disciplinary problems,
• Paranoid ideation,
• Delusional statements,
• False information,
• Actual threats of violence.

You may be able to defuse the situation by exhibiting a firm but calm demeanor while allowing the person to vent concerns, acknowledging them, and empathizing. At the same time, remain vigilant for signs that danger is escalating, notify others of suspicious individuals or actions, and try to identify an escape route. In the worst-case scenario, when an attack has begun, you have three options: run, hide (preferably behind a locked door), or fight (if all else fails).

Make sure your practice has a detailed plan in place for dealing with violent incidents, including how and when to escape, how to protect patients, and how to cooperate with law enforcement.

Additional resources:

• AAFP Violence in Healthcare Toolkit
  
• Crisis Prevention Institute – 10 Tips for Crisis Prevention
• Department of Homeland Security – Active Shooter Preparedness
• ECRI — Violence in Healthcare Facilities
• FPM — Incivility in Health Care: Strategies for De-escalating Troubling Encounters
• Occupational Safety and Health Administration — Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers
• Run, Hide, Fight: Surviving an Active Shooter Event (video)

See the full FPM article: “How to Prepare for and Survive a Violent Patient Encounter.”

1. Workplace violence. Occupational Safety and Health Administration. Accessed July 29, 2021. https://www.osha.gov/workplace-violence