Violence in general practice: a gendered risk?

Elston, Mary Ann; Gabe, Jonathan

doi:10.1111/1467-9566.12373

Cited by 15 publications

(24 citation statements)

References 17 publications

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“…Fear and embarrassment are well-established inhibitors of engagement with patients; embarrassment gets in the way of clinicians investigating sensitive topics (Tomlinson, 1998) or undertaking intimate examinations (Hine & Smith, 2014), while fear of aggressive patients impedes the patient-provider relationship (Elston & Gabe, 2016). In the view taken in the current work, the elicitation of avoidance-promoting emotions is central to problematic clinical engagement.…”

Section: Statement Of Contributionmentioning

confidence: 89%

“…In the view taken in the current work, the elicitation of avoidance-promoting emotions is central to problematic clinical engagement. Fear and embarrassment are well-established inhibitors of engagement with patients; embarrassment gets in the way of clinicians investigating sensitive topics (Tomlinson, 1998) or undertaking intimate examinations (Hine & Smith, 2014), while fear of aggressive patients impedes the patient-provider relationship (Elston & Gabe, 2016). However, considerably less is known about how disgust might impact clinical interactions.…”

Section: Statement Of Contributionmentioning

confidence: 99%

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Fighting the flinch: Experimentally induced compassion makes a difference in health care providers

Reynolds

Powell

Lin

et al. 2019

British J Health Psychol

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Objectives. Although health care providers are required to sustain care in difficult circumstances, some patients challenge this principle. Evoking compassion seems likely to be helpful in such situations. This research aimed to evaluate whether inducing compassion in health care providers might mitigate disengagement with patients who have challenging presenting features such as those with disgusting symptoms and/or are to blame for their own health problems.Design. An online experimental study with clinical health care providers.Methods. Medical students (n = 219) and qualified health care professionals (n = 108) took part in an online experiment. Participants were randomized to view a slideshow of either neutral images (control) or compassion-inducing images (compassion condition) and were then presented with a series of patient vignettes where presenting problems systematically varied on patient responsibility and disgusting symptoms. Engagement was assessed by asking participants how caring they felt, how much they would want to help, how challenging it would be, and whether they would wear a mask.Results. Participants reported less engagement with patients who were responsible for their illness and who presented with disgusting symptoms. Induced compassion offset disengagement and qualified health professionals were more caring and willing to help patients than medical students. The compassion induction eliminated some differences between experienced and trainee clinicians.Conclusions. This research demonstrates that disgust and patient responsibility impacts clinical engagement and that medical students are more impacted by such scenarios than qualified health providers. Inducing compassion may help to mitigate these differences, and further investigation into strategies that foster engagement with difficult patients is warranted.

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Section: Statement Of Contributionmentioning

confidence: 89%

Section: Statement Of Contributionmentioning

confidence: 99%

Fighting the flinch: Experimentally induced compassion makes a difference in health care providers

Reynolds

Powell

Lin

et al. 2019

British J Health Psychol

View full text Add to dashboard Cite

show abstract

“…Demographic changes in the physician population should also be considered. As the percentage of female physicians increases, preventive measures should focus on female physicians to reverse the trend of increasing patient-physician aggression 17 23. Because one third of the male physicians experienced aggression too, they might also benefit from preventive actions.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types

et al. 2019

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ObjectivesThe aim of this Belgian research study was to describe the characteristics of physicians who are at increased risk for patient-physician aggression. Second, aggression subtypes were described and data were provided on the prevalence of patient-physician aggression in Belgium.DesignCross-sectional survey.SettingPrimary and secondary care inside and outside hospitals.ParticipantsAny physician who had worked in Belgium for the preceding 12 months was eligible to participate (n=34 648).Main outcome measuresAn online, original questionnaire was used to obtain physician characteristics (eg, age, sex, native language), department, working conditions and contact with aggressive patients during their career and during the preceding 12 months.ResultsThe questionnaire was completed by 4930 participants and 3726 (76%) were valid to take into account for statistics. During the preceding 12 months, 37% had been victims of aggression: 33% experienced verbal aggression, 30% psychological, 14% physical and 10% sexual. Multiple answers were allowed. Women and younger physicians were more likely to experience aggression. Psychiatric departments and emergency departments were the settings most commonly associated with aggression. Physicians who provided primarily outpatient care were more subject to aggression.ConclusionBelgian physicians experience several forms of aggression. Those most at-risk of aggression are young and female physicians who work in outpatient, emergency or psychiatric settings.

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“…The 12-month prevalence of aggression towards general practitioners (GPs) was 54.9% for verbal aggression and 23.4% for physical aggression 1. In a survey in the UK 78% of all GPs experienced at least one verbal incident in the previous 2 years 2. A recent cross-sectional study among Flemish GPs showed that only about 5% never encountered aggression.…”

Section: Introductionmentioning

confidence: 99%

Interventions to prevent aggression against doctors: a systematic review

Raveel

Schoenmakers

2019

BMJ Open

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ObjectiveTo find out if there is evidence on interventions to prevent aggression against doctors.DesignThis systematic review searched the literature and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.Data sourcesPubmed, Embase, Turning Research into Practice (TRIP), Cochrane and Psycharticle, GoogleScholar andwww.guideline.govwere consulted.Eligibility criteriaAbstracts published in English between January 2000 and January 2018 were screened. Eligible studies focused on prevention and risk factors of type II workplace violence in general healthcare, psychiatric departments, emergency departments, emergency primary care, general practice.Data extraction and synthesisThe selected intervention studies were grouped into quantitative and qualitative studies. Systematic reviews were reported separately. For each study, the design, type of intervention and key findings were analysed. Quality rating was based on Grading of Recommendations, Assessment, Development and Evaluation (GRADE) and GRADE-Confidence in the Evidence from Reviews of Qualitative Research (CERQUAL).Results44 studies are included. One randomised controlled trial (RCT) provided moderate evidence that a violence prevention programme was effective in decreasing risks of violence. Major risk factors are long waiting times, discrepancy between patients’ expectations and services, substance abuse by the patient and psychiatric conditions. Appropriate workplace design and policies aim to reduce risk factors but there is no hard evidence on the effectiveness. One RCT provided evidence that a patient risk assessment combined with tailored actions decreased severe aggression events in psychiatric wards. Applying de-escalation techniques during an aggressive event is highly recommended. Postincident reporting followed by root cause analysis of the incident provides the basic input for review and optimisation of violence prevention programmes.ConclusionsThis review documented interventions to prevent and de-escalate aggression against doctors. Aggression against physicians is a serious occupational hazard. There is moderate evidence that an integrated violence prevention programme decreases the risks of patient-to-worker violence. The review failed to gather sufficient numerical data to perform a meta-analysis. A large-scale cohort study would add to a better understanding of the effectiveness of interventions.

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Violence in general practice: a gendered risk?

Cited by 15 publications

References 17 publications

Fighting the flinch: Experimentally induced compassion makes a difference in health care providers

Fighting the flinch: Experimentally induced compassion makes a difference in health care providers

Cross-sectional study on patient-physician aggression in Belgium: physician characteristics and aggression types

Interventions to prevent aggression against doctors: a systematic review

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