Violence in Healthcare Part 1: Risk Factors & Warning Signs
Once you have an understanding of the risk factors and warning signs that may lead to workplace violence in a healthcare setting, it’s imperative to implement a plan to prevent and intervene in these situations to provide a safe environment.
Only the common cold prompts more people to see a practitioner than acute low back pain. Most people will suffer with low back pain at least once in their lives, and it is estimated that 2% to 3% of all ED visits are for acute non-traumatic back pain. With costs exceeding $90 billion per year, the far-reaching implications are clear. Acute low back pain affects men and women of all ages; it is a common cause of disability in those less than 45 years of age due to work-related injury. Patients experience pain and lost wages; employers are impacted by loss of productivity in the workplace; and there is a major financial burden to society in general.
Pinched, pushed, punched, or even stabbed, shot or killed. Nearly every healthcare worker has been a victim or knows a coworker who has been a victim of workplace violence.
Workplace violence represents a serious health and safety concern for all employees, but healthcare workers in particular face significant risk. Health and social service industries account for 48% of all non-fatal injuries from occupational assaults and violent acts.
Many practitioners view the process of informed consent in healthcare to be a nuisance and a hindrance. It is often simply one more hoop to jump through so that the patient can get the care he or she needs. This is not true. If the provider was negligent in providing the service and a bad outcome occurred, the patient has a cause of action for medical malpractice.
The discoverer of penicillin, Sir Alexander Fleming, warned many decades ago that the “public will demand [the drug and]…then will begin an era…of abuses.” His prophecy has been realized, and I readily confess that I am guilty. During my 37 years in family practice and emergency medicine, I admit that I prescribed antibiotics for viral and self-limited illnesses. There were times when I bowed to pressure from ill and desperate (but not desperately ill) patients or their parents who demanded a cure for an upper respiratory infection.
A 35-year-old female presents at 0321 by ambulance with a complaint of chest pain. The records show EMS arriving at her house and finding the patient on the couch.
EMT Notes
Patient appears to be anxious and hyperventilating.
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Arriving at the correct diagnosis sometimes follows a short and simple journey.
Consider the classic case of shingles, for example, where the one-step process consists of recognizing the tell-tale pattern of vesicular lesions. Contrast the rash of shingles with the more elusive symptoms of chest pain, headache, or weakness, which usually require a multi-step approach to reach the correct conclusion.
As clinicians, we were all taught the “diagnostic process” in some shape or form. What we didn’t always learn is that each step in the process is accompanied by potential missteps that can take us down the path to misdiagnosis.
The possibility of cyber liability (the threat of liability due to unlawful access to electronic data) has been in the news recently. The reports of security issues include losses by large and small providers. Based on the reports in the media, it would appear that no one is immune to this threat. While there can be no guarantee of immunity, there are things that healthcare providers can do to reduce the threat of loss.
Is there a reliable way to predict which physician will be sued for malpractice? Researchers, insurers and healthcare professionals have wrestled with this question for decades.
A recent study in the New England Journal of Medicine and a follow-up response by the Physician Insurers Association of America (PIAA) provide more data points, but admittedly do not answer the question definitively. Perhaps they are trying to answer the wrong question.
A 78-year-old man, Mr. S, came to the emergency department with the chief complaint of abdominal pain. He was an active person, residing in the independent living section of a retirement complex. He described the pain as an ache in the mid and lower abdomen that had been present for several days. The pain did not radiate. He denied any fever, nausea, vomiting or diarrhea. He claimed having no appetite or bowel movement “for days.”
