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Doctor Abuse Fuelled By Staff Shortages and Waiting Lists

In the past year more than half of UK doctors had experienced or witnessed verbal or physical abuse from patients or their relatives, a survey found, with staff shortages and referral waiting lists blamed.

The following are just a handful of the examples of experiences of doctors in a Medical Protection Society (MPS) survey of 861 doctors in the UK, fielded from 20 March to 17 April this year.

  • "Patient's partner threatened to kill me as he felt his wife had waited too long to be seen."
  • "I have been backed up against a wall by parents who wanted better nursing for their child in intensive care. We literally had no staff."
  • "My team and I have been verbally abused, threatened and spat at."

Of those doctors who had experienced or witnessed abuse in the past 12 months, over half (56%) said they had experienced or witnessed verbal or physical abuse from patients or their relatives, with similar numbers blaming the incidents on staff shortages (48%) and referral waiting lists (45%).

MPS President, Professor Dame Jane Dacre, commented: "While staff shortages and long referral waiting lists are frustrating and stressful for patients and their families, healthcare professionals are doing their best in very difficult circumstances." She added that whilst many patient interactions were positive, it was distressing that so many healthcare workers faced daily verbal and physical abuse from patients.

Abuse of Doctors Should Not Be Normalised

Dr Latifa Patel, British Medical Association (BMA) workforce lead, acknowledged to Medscape News UK that patients – who she said mostly interacted with the health service in pain and distress – were "understandably frustrated". However, she urged the public "not to take out their exasperation on doctors or our colleagues, who share the same frustrations and are acutely aware that waiting times are too long".

Dr Adrian James, president of the Royal College of Psychiatrists, told Medscape News UK: "Every day, doctors come to work to do the best for their patients but we cannot continue to expect them to do so in an environment where they experience threats, violence and abusive behaviour. Doctors are not empty white coats; they are people, and these incidents can have a serious and lasting impact on their mental health."

Director of Policy and Strategy at NHS Providers, Miriam Deakin, told Medscape News UK: "The increase in incidents of violence against staff is deeply concerning and these new figures show that this happens far too often, laying out in stark detail the devastating impact verbal and physical abuse can have on staff morale, as well as physical and mental wellbeing."

Another worry was the "notion that abuse is becoming 'part of the job', with some healthcare professionals becoming desensitised to it and, therefore, neither reporting nor seeking support following incidents," alerted Professor Dacre.

"Facing such abuse should not be accepted as an occupational hazard," said Dr Patel.

"Abuse against healthcare professionals should not be normalised," Professor Dacre warned. Experiencing and witnessing abuse could have a "lasting and profound" impact on mental health and this could be damaging for the individual as well as for patient care, she cautioned. "It can also result in healthcare professionals needing to take time off work, and even quitting medicine altogether," she stressed.

Devastating Impact on Staff Morale and Wellbeing

With the NHS in the throes of a staffing crisis, and with many doctors suffering the mental health consequences of inadequate staffing levels and increased patient demands, it was of great concern that more than 8 out of 10 (85%) of the doctors surveyed said that the abuse affected their mental health, and for 43% of those who had seen or witnessed verbal or physical abuse from patients or patients' relatives in the past 12 months it had had a "significant or moderate" impact on their mental wellbeing. 

"These incidents leave doctors fearing for the safety of themselves, colleagues, and loved ones, which can have a profound effect on their wellbeing. It can even leave the most resilient doctor questioning their career at a time when the NHS simply can’t afford to lose any more staff," Dr Patel emphasised.

For around 1 in 4 (24%), the increase in abuse and intimidation from patients had made them consider their career in healthcare.

Last month, the Dean of the Royal College of Psychiatrists, Professor Subodh Dave, remarked how psychiatrists were "retiring or leaving the field, in no small part because of burnout and low morale caused by excessive workloads". Feedback from College members suggested that chronic workforce shortages, burnout from excessive workloads, and poor work-life balance were contributing to many consultants considering early retirement or leaving the profession entirely - issues that stemmed from working in an "overstretched and understaffed system".

Professor Dacre urged that all healthcare settings should provide an appropriate forum where those who witnessed or experienced any kind of abuse from patients could talk about it and seek appropriate wellbeing support. "It is not enough to just have this safe space – staff need to know it exists and be encouraged to use it," she said.

Abused Doctors Not Taken Seriously By Law Enforcement

Dr Patel pointed out that the BMA offered a range of wellbeing support services to doctors, medical students and their dependants. "However, when these unacceptable incidents occur it's important that police forces ensure action is taken against perpetrators," she stressed.

However, the survey discovered that nearly a third of doctors (31%) felt abuse against healthcare professionals was not taken seriously by police.

Dr James sympathised with patients who had become frustrated by long waiting times, and stressed it was important to note that some patients exhibiting these behaviours may be doing so in the "midst of a mental illness crisis", but doctors needed to know that they would be listened to when they reported these incidents.

"Police and crime commissioners, and police forces across the UK, should consider how they can support local healthcare settings, for example, by encouraging reporting of abuse and offering practical advice on recognising warning signs or de-escalation techniques," suggested Professor Dacre.

She highlighted that there were some positive examples of police forces and commissioners engaging with local medical committees following GPs' concerns over rising abuse and underlined that "these should be learned from". 

Trust leaders were taking measures to protect their staff – ranging from specialist de-escalation training, down time for staff after these incidents, and even body cameras," explained Ms Deakin. "But this shouldn’t have to be the case."

There was a need for research to ascertain the additional training needs for staff across the NHS for dealing with conflict and protecting themselves from violence, stressed Professor Dacre.

Public Expectation Needs to be Managed

Dr Patel agreed: "NHS employers must also do all they can to deter poor behaviours and support and protect staff ensuring appropriate reporting channels are available to them."

Professor Dacre stipulated that the zero-tolerance policy to abuse must be "rigorously enforced" right across the NHS, so healthcare workers felt their safety was a priority and were empowered to report all abusive behaviour. "The policy must also be visible to patients, as a deterrent," she stipulated. 

It was equally important to remind the public to recognise and understand the immense strain that the understaffed and under-resourced NHS was under when interacting with healthcare staff, the BMA highlighted. "The Government must also issue public messaging to manage patient expectation and prevent staff bearing the brunt of frustration and anger," the BMA said.

"Violence against any member of NHS staff is completely unacceptable – there is absolutely no excuse to take this out on the staff who are there to help them," Ms Deakin said.

"Abusive, threatening, or violent behaviour towards our NHS doctors who are working under immense pressure and doing their absolute best to care for patients is illegal, unfair, and will not be tolerated," Dr Patel added.

The issue was exacerbating the chronic workforce shortages that were preventing patients from accessing care quickly, underlined Dr James. "The NHS must work alongside the Government and police to develop plans to tackle this issue so that more people want to join and remain in the profession."

The Government, police, and NHS employers must take every possible step to tackle the issue, stressed Professor Dacre. "If we don’t act, we may lose many more skilled, committed healthcare workers at a time when the profession can ill-afford it."