Ensuring a safe working environment for doctors

Workplace violence against doctors is an unfortunate reality of medical practice in Bangladesh as well as in other countries. The World Health Organization (WHO) defines workplace violence as “incidents where staff are abused, threatened or attacked in circumstances related to their work, including commuting, involving an explicit or implicit threat to his safety, welfare, or health”.

Workplace violence is a major occupational hazard for professions that involve providing direct services to people; thus, healthcare professionals, including nurses and doctors, are classified as high-risk due to the very nature of their work. This has a huge impact on the physical and psychological well-being of doctors and nurses and ultimately disrupts the effectiveness and efficiency of the health service delivery system. Patients or their family members or friends can trigger episodes of violence and these are quite common in South Asian countries, especially in emergency departments, psychiatric wards and care units. intensive. A common precursor to violence against physicians is the dissatisfaction of patients and their caregivers with the service they receive. To complicate matters further, in general, doctors often earn little sympathy from the general public in Bangladesh, as many here regard doctors as ruthless, greedy and indifferent to the welfare of the patient.

Workplace violence against doctors has unfortunately become more recurrent in Bangladesh as the need for and access to health care has increased. The following few recent episodes are from newspapers:

Event 1: On July 18, 2021, a patient was rushed to the emergency room of Gaibandha Sadar Hospital. She died later. A group of people, including relatives of the deceased patient, then carried out attacks on doctors, nurses and staff. They physically assaulted doctors and other health officials and also vandalized the hospital’s emergency department.

Event 2: A doctor was assaulted by relatives of a patient who died on June 19, 2019 at Barguna General Hospital. He was beaten by relatives of a deceased patient, in an altercation that ensued at the hospital that day.

Event 3: A doctor and owner of a private clinic and diagnostic center died while being treated at the intensive care unit of Shaheed Sheikh Abu Naser Specialty Hospital in Khulna on June 17, 2020. A mother’s death after giving birth to a baby at the clinic led to a fight with a patient’s relatives and he was injured in the fight.

The health sector in Bangladesh in general witnesses a large number of cases of violence, especially against primary health care providers. Most young doctors, inmates and nurses are victims of this, which has a negative impact on their physical and psychological well-being, which, in the long term, limits their work performance and decreases their job satisfaction. A dangerous and threatening work environment affects the functioning and efficiency of the health care delivery system.

Several research studies around the world have attempted to understand the risk factors and predictors that cause such incidents. Some factors identified are patient-related (e.g. gender (especially male), low literacy, influence of drugs or alcohol, personality type, dissatisfaction with service, previous bad experience of medical services, high or unpredictable cost of services, mental disorders, inadequate adherence to treatment); some are physician-related (eg, gender (especially female), lower college degree, shift work, stress, anxiety, certain personality traits, poor communication, rude and indifferent behaviors, inability to reduce emotional state patients). Organizational factors also play a role (eg, psychiatry, intensive care or emergency departments, lack of equipment and resources, overcrowding of the facility, long wait times, delay or interruption of service, workload high work schedule, insufficient skills and mix, poor communication, lack of security, poor safety culture, lack of guidelines and protocol on how to handle difficult situations). Social or cultural factors also play a role (e.g. language barrier, lack of respect for authority in general, distrust, negative image of healthcare professionals due to media reports and lack of social structure such as local government in general). Awareness of this problem and its methodical resolution can reduce the incidence of violence against physicians.

A recent study summarized different strategies to reduce workplace violence. Some of these apply at the individual level: training doctors on 1) how to handle disagreements and communication problems, 2) avoid false promises, especially in difficult situations, 3) obtain prior consent from patients or families before starting treatment, 4) improve problem -solving. It was strongly recommended to incorporate more modules on effective communications and interpersonal skills into the medical curriculum and to learn how to convey bad news. Strategies at the organizational level include 1) installing CCTV cameras and other security systems in high-risk areas, 2) setting up metal detectors, alarm systems, a adequate lighting in all corridors and corners, 3) restricting the entry of a certain number of relatives or friends of the patients, 4) improving the doctor-patient ratio, 5) implementing technology to ensure faster service delivery, 6) have a transparent billing system, and 7) have an active grievance system policy. At the societal level, unbiased media reporting, reducing undue interference by local politicians, inviting religious leaders to counsel those in distress, and educating local communities about human health, disease, results and limitations of hospital or medical care can help.

Workplace violence is understood as any type of act, incident or behavior in which the victim is abused, threatened, disgraced or beaten in the workplace. Violence is characterized differently: physically (eg, hitting, pushing, and kicking), verbally (eg, shouting, name-calling, and offensive comments), or sexually (eg, making comments or jokes, touching). A comprehensive review of incidents of workplace violence against physicians, a better system for reporting cases, outlining the degree and types of violence, understanding risk factors, and highlighting the impact of violence on physical and psychological health will help to develop intervention strategies and implement practical actions to improve physician safety in Bangladesh.

Dr Hasnat M Alamgir is Professor of Public Health

[email protected]