• Guest Editorial

    Embrace Your Role in Ending Violence Against Physicians

    August 25, 2022, 2:00 p.m. Eleanor Lisa Lavadie-Gomez, M.D. — Ask any family physician how they feel when they read or hear about workplace violence involving fellow physicians, and they will express the same unsettled feelings: We experience a sinking sensation in the pit of our stomach and mourn the injury or loss of one of our own.  

    violence prevention word cloud

    This is how I felt when I heard about the June 1 shooting in Tulsa, Okla., that claimed the lives of four victims, including Preston Phillips, M.D., and Stephanie Husen, D.O. The gunman also fatally shot himself.

    In my 10 years of practice since graduating from residency, I can recall distinct experiences of verbal aggression or intimidation from patients, even from those with whom I had formed continuity relationships in my daily clinic practice.

    I remember one patient who was assigned to me after his primary care physician was no longer available. He had a host of chronic conditions — including hypertension, chronic tobacco use, history of alcohol abuse and arthritis — and he suffered from chronic pain. He could not take NSAIDS due to the hypertension, and a recent flare of shoulder pain brought him in for frequent visits.

    The patient’s options for pain control were limited, beyond extra-strength acetaminophen and topical pain relievers, and I stood my ground to not prescribe opiate medications, despite his insistence.

    He had a persistently gruff demeanor and was unpleasant to office staff, and one evening he left a threatening message on the voicemail about me, after which he was promptly discharged from the practice.

    Such experiences reinforce the fact that pain is as much a psychological experience as a physical one, and a person’s tolerance for pain can also be informed by a history of trauma and other ongoing stressors, often beyond the physician’s control.   

    We know all too well that the pharmacology of opiate medications means that patients develop tolerance to their pain-relieving effects with chronic use, and we also know that chronic noncancer pain is an epidemic all its own in our country. And although the purpose of this editorial is not to further delineate the opiate epidemic, but to highlight the problem of violence against physicians and health care professionals in the United States, it’s worth noting how frequently these two serious health scourges intersect.

    Data released by the U.S. Bureau of Labor Statistics in April 2020 reveals that health care workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018, with the largest proportion of these events associated with psychiatric hospitals and facilities that treat patients with substance use disorders. Overall, the incidence rate of nonfatal workplace violence to health care workers in the United States rose from 6.4 per 10,000 workers in 2011 (when the current version of the Occupational Injury and Illness Classification System was introduced) to 10.4 per 10,000 workers in 2018.

    Pandemic-driven Rise in Attacks

    Unfortunately, the COVID-19 pandemic appears to have exacerbated violent outbreaks against health care workers both here and around the globe, as outlined in a report spearheaded by the International Committee of the Red Cross titled “Violence Against Health Care: Current Practices to Prevent, Reduce or Mitigate Violence against Health Care.” The report defined violence as ranging from verbal aggression and threats to physical aggression or severe physical harm — including death of a health care worker or patient. Its chief finding: Nearly 60% of health facilities surveyed have seen an increase in reported cases of workplace-related violence against health care personnel, patients or facilities since the pandemic began.

    To reaffirm that increasing violence against physicians and other health care workers is a global problem, the World Medical Association has labeled it an “international emergency” that “undermines the very foundations of health systems and ultimately impacts critically on patients’ health.”

    AAFP Preventing Violence Toolkit

    One year ago, the AAFP released its Preventing Violence in Health Care Toolkit, which is a compendium of resources designed to assist family physicians in

    • preparing their practices to assess and mitigate violence risk in workplace settings,
    • training clinic staff to de-escalate potential violence, and
    • responding to active shooter situations.

    The toolkit can be especially useful for smaller practices, which may not be part of larger institutions such as teaching hospitals or multispecialty practice settings that often have these trainings already in place. It is important that family physicians access the tools available to them to help protect themselves, their staff and their patients regardless of practice setting — whether in a clinic, hospital or school, or when caring for individuals who are incarcerated or experiencing homelessness.

    Additional AAFP Resources and Advocacy

    • The AAFP has been working to address gun violence for many years, and was quick to issue a response decrying the mass shooting in Uvalde, Texas, and urging support for legislation to better regulate access to firearms. One month later, the Academy lauded passage of the Bipartisan Safer Communities Act, which aims to curb firearms violence via a number of means, including by enhancing background checks and boosting funding for mental health services and mental and behavioral health training for primary care physicians.
    • The AAFP policy “Violence, Illegal Acts Against Physicians and Other Health Professionals” clearly condemns all violent and illegal acts against physicians and other health care professionals.
    • The AAFP has endorsed the Health Care Providers Safety Act (H.R. 7814/S. 4268), identical versions of which were introduced in both the House and Senate in May. If passed, the legislation would establish a grant program for health care professionals and would enable them to enhance physical and cybersecurity of their facilities, personnel and patients.

    Driven by its mission statement — “Improve the health of patients, families, and communities by serving … members’ needs,” — the AAFP provides resources and advocates on behalf of all family physicians to ensure a safe environment in which to practice medicine and to ensure our patients receive the care they need.

    Get Involved, Informed and Active

    I encourage you to become engaged in this bold undertaking by denouncing workplace violence, educating yourself on best practices for workplace safety and staying informed about legislative actions that will affect us all.

    The complexity of problems affecting family physicians must be reflected in our advocacy and in our voices. Share your stories, become active in your state chapters, and contact your legislators. We sacrifice so much, and we need to continue to care for ourselves and for one another.

    Eleanor Lavadie-Gomez, M.D., of Iowa City, Iowa, a former member of the AAFP Commission on Health of the Public and Science, helped develop the Academy’s position paper on violence and its policy statement on harassment and bullying, both of which are included in the Preventing Violence in Health Care Toolkit, as well as its position paper on violence in media and the entertainment industry.