4 Ideas to Stop Harassment by Patients

A doctor offers four recommendations to curb harassment and assault against healthcare providers.

A Massachusetts-based physician is calling on the healthcare community to develop more effective responses to patients who engage in harassment or other negative interactions.

"There is only a relatively small body of literature on harassment in medicine, and it tends to focus on acts committed by colleagues and superiors rather than by patients or clients," Charlotte Grinberg, MD, wrote in an article for Health Affairs.

"Clearly, patients can also be offenders. This should not be ignored."

Grinberg, resident physician at Mount Auburn Hospital in Cambridge, Massachusetts, shares three incidents from her past to illustrate potentially dangerous workplace environments:

• When she was a sophomore in college, Grinberg did GED tutoring at a correctional facility. After an inmate masturbated during a tutoring session, she reported the incident to a guard, who said, "These things sometimes happen."
   
• As a second-year medical student, Grinberg volunteered at a homeless shelter, where she connected residents with community resources. After a resident with whom she had worked was charged with raping a store clerk, it changed her: "I kept the visits brief. I avoided physical contact. I didn't give out my phone number or offer to call patients on other days of the week to follow up."
   
• In her third year of medical school, an end-stage liver disease inpatient tried to pull Grinberg into his bed while making sexually suggestive comments. "I wondered if this was somehow my fault, and how I could ever provide care to Steven again," she wrote.

Although all three incidents were reported, only the inpatient encounter was reviewed. "I started feeling little less alone and a little less responsible," Grinberg wrote.

There are rarely easy answers when patients harass or assault their caregivers, she wrote, "Sometimes, these assaults are by-products of diseases such as psychosis and dementia. We wouldn't want to react to someone who lashes out because of dementia in the same way we react to someone who is lashing out for reasons within their control."

She offers four recommendations to curb harassment and assault in healthcare settings:

• There is widespread promotion of safety incident reporting. Similarly, healthcare organizations should foster workplace environments where it is safe to report harassment and other negative interactions with patients.
   
• Raise awareness among healthcare staff members about the potential for patients to engage in harassment and assault, and explain the benefits of reporting incidents.
   
• Form a culture that allows caregivers to discuss incidents with patients directly. "Our duty is to serve all patients, no matter what sort of people they are. But this does not mean we need to accept or ignore abuse," Grinberg wrote.
   
• Carefully examine existing interventions to guide the creation of new policies. "Such policies will help doctors like me in the future and ensure that although these things do sometimes happen, there is something we can do about them," she wrote.