Aggression and violence directed toward physicians

Physicians harmed by the people for whom they provide care experience a unique type of workplace violence. Because general internists have responsibilities in a wide range of clinical settings, the potential for aggression and violence is a realistic concern. The significant emotional, psychological, and financial costs of violence make this an important issue for us all. It is crucial for general internists to recognize the various forms of violent behavior, to address the clinical and institutional factors that both perpetuate and result from patient violence, and to be aware of the appropriate security measures to take in a dangerous situation. Guidelines published by OSHA, the Joint Commission on Accreditation of Health Care Organizations, and a number of professional organizations such as the American Medical Association and American Psychiatric Association are valuable resources for practicing clinicians and educators. The three cases we have presented exemplify how aggression and violence can manifest in the internal medicine setting. Within internal medicine, it is likely that certain clinicians are at increased risk, such as those who care for patients in the emergency department, on psychiatric wards, in substance abuse programs, and in prisons. Regardless of where one trains or practices, however, the possibility of encountering an aggressive or violent individual will always exist. The belief that physicians are exempt from physical violence because of their status, power, prestige, or knowledge is a myth. Efforts to address this problem should be aimed at better understanding the situations in which violence occurs and the unique way in which violence affects general internists. Future research is needed to describe the epidemiology of aggression and violence toward physicians and to evaluate the efficacy of educational programs and interventions designed to prevent its occurrence.