Are we doing enough to deter violence in general practice?

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An encounter with an aggressive patient and the resulting fallout were enough for a general practitioner to consider stepping away from the profession.

Dr Alvin Chua described a violent incident in his medical practice as “the straw that broke the camel’s back”.


The pandemic has cast a harsh light on many societal issues, including the potential for violence directed at healthcare professionals.


General practice teams, particularly in clinics offering COVID-19 vaccinations, “were often the target of patient frustration and sometimes aggressive behavior,” an RACGP submission at the Australian National Audit Office reported last year.


But the problem has certainly not been limited to those involved in the deployment – as Adelaide-based GP Dr Alvin Chua knows all too well.


A violent encounter in his general medicine practice at the start of the pandemic alienated him from the profession.

 

He says the incident happened after he intervened when a man walked into surgery and started using racial slurs against a receptionist. Dr Chua describes being pushed backwards by the man, losing his footing and hitting his back.

This triggered a series of deeply upsetting events for Dr. Chua, including the discovery of pre-existing spinal stenosis and ossification of the posterior longitudinal ligaments.

A cadaver bone graft was performed, which then collapsed, and another operation followed, with two rods and 10 screws inserted into his spine. Dr Chua said he felt pain like never before.

Following a thoracic laminectomy, myelomalacia of his spine at the thoracic level was also discovered and he remains in severe discomfort.

“Maybe he did me a favor, maybe he didn’t, but in the end it was the straw that broke the camel’s back,” he said. he declares. newsGP.

The increase in violence against healthcare professionals is by no means limited to Australia.

In May 2020, the World Medical Association described it as “an international emergency”claiming that the problem grew over the past decade and then “expanded dramatically” as COVID-19 spread.

Research based on meta-analyses and systemic reviews that took place before the pandemic revealed 61.9% of healthcare workers participants had been exposed to some form of workplace violence, including non-physical abuse.

Concerning general medicine more specifically, a study published in the British medical journal in April reported a sharp increase in incidents over previous years, including physical violence.

Using freedom of information requests sent to police forces across the country, investigators uncovered 1,068 incidents of violence in UK health centers and doctors’ surgeries in 2021-22 – including 182 resulting in injuries.

The figures were described by a UK GP as ‘the tip of a much, much bigger iceberg’.

But it wasn’t just the violence that Dr. Chua found daunting.

Dr Chua is also deeply disappointed with the police response to the assault on GP as no charges have been laid despite an affidavit.

At the same time, he had to deal with a notification from the Australian Health Practitioner Regulation Authority (AHPRA), triggered by the man who assaulted him, which he became aware of on the day of his first operation. He was only rejected without prejudice the day he had surgery for the second time.

“It made me want to leave the profession,” Dr. Chua said.

Dr Cameron Loy, former President of RACGP Victoria and recipient of the RACGP Rose-Hunt Award, is another GP who has been attacked in the line of duty – once in GP and once while working In a hospital.

He understands Dr. Chua’s anger.

“What happened to Alvin is horrible,” he said. newsGP. ‘This should never have happened. His grievance that the system failed to protect him is absolutely valid.

Dr Loy says most of the time GPs carry out their work without any problems – but violence in GP is ‘not new’.

“The data suggests it’s very common and the violence isn’t just physical,” he said. “There are forms of verbal and other abuse that occur in general practices.”

Dr Loy thinks there is room for reform, with many healthcare workers – as happened with Dr Chua – finding that incidents go unheard in the courts.

“I know that has been true in my cases,” he said.

“The appetite for that to happen and how you affect that change is a much, much harder question.”

He thinks part of the answer lies in how the courts, the police and the community perceive aggression towards doctors and other healthcare workers.

“I want Mrs. Smith to be as angry as I am that Alvin Chua was assaulted,” he said. “But I don’t know if she even knows.”

The legal context

Distinguishing between different legislative approaches can be tricky with state-specific criminal laws.

Another complication is that GP practices are categorized as small businesses, while in some cases government-employed healthcare workers may be offered greater protection – at least in the letter of the law. law – in the face of aggression.

Dr Chua is keenly aware of the disparities and angrily points to a bill recently tabled in New South Wales that would offer tougher mandatory sentences for assaults on hospital staff and pharmacists, but not GPs.

As pointed out recently in The Medical Republic, a 2020 NSW Sentencing Council report examining violent offenses against first responders, endorsed the case for harsher punishments for assaults on hospital workers. The report does not have the same point of view for general medicine.

“We have received no evidence that assaults on healthcare workers in other healthcare settings, such as GP clinics or community health clinics, are a particular problem,” the report said.

“We have no evidence to justify extending the new offenses to these locations.”

Although this report does not mention pharmacists under the definition of frontline health workersthe bill in NSW parliament does – as well as the omission of GPs.

Submissions from other organizations to sentencing counsel also reflect some of the nuances and complexities raised by Dr. Loy.

The Young Lawyers NSW argued that the definition of health workers should be broader, while NSW Bar argues that “an appropriate range of offenses and penalties” already exists, and that there would be “limited gains” from changing maximum penalties.

AMA NSW argued that mandatory sentencing would limit a judge’s ‘discretion to consider mitigating factors’. It could also “disproportionately affect those who are already overrepresented in the prison system, such as Aboriginal and Torres Strait Islander people,” according to their submission.

Meanwhile, an article published the Frontiers in public health review in 2020 says evidence surrounding the effectiveness of such interventions “is still lacking.”

‘[Healthcare workers] around the world generally advocate tougher laws, but tougher penalties alone are unlikely to solve the problem,” the report said.

Its authors, however, recommend a fierce stance against acceptance.

“The idea that violence is inherent in the work of doctors and nurses, especially in certain departments, must be combated,” they wrote.

“Urgent measures must be implemented to ensure the safety of all healthcare workers in their environment, and the necessary resources must be allocated.

“Failure to do so will worsen the care they are employed to provide and ultimately negatively affect the entire healthcare system worldwide.”

Dr. Loy is also adamant that the type of incidents he experienced, along with Dr. Chua and so many others, should never be considered “just part of the job”.

“Is violence a characteristic of our society? Yes. Man is a violent species. I think we have a whole evolution that demonstrates that,” he said.

“Should it just be part and parcel of working in medicine? No, it shouldn’t.

“I do not go to work to be verbally or physically abused by patients or their families.

“We should never accept it, there should be absolutely no tolerance for this to happen.”

The RACGP has the following resource available to members at coping with patient aggression.



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