In responding to a Medscape poll asking whether they had been harassed by a patient, many more nurses (71%) than physicians (47%) said yes.
The poll questions were posed December 20 by Medscape Medical News. Responses totaled 1045 and included 569 nurses, 408 physicians, and 68 other healthcare providers (HCPs).
Harassment was defined in the poll as patients stalking, persistent attempts at communication, and inappropriate social media contact. One of the questions addressed physical harassment.
More than twice as many women took the poll as men. While 41% of the physicians were female, a full 90% of the nurse were female, as were 66% of the HCPs.
By gender, female nurses and physicians were much more likely to say they had been sexually harassed than their male counterparts (73% for female nurses vs 46% for male nurses, and 58% for female vs 39% for male physicians).
Those in the HCP group, which included specialties such as dietitian/nutritionists, physical therapists, chiropractors, and paramedics, fell in the middle, with 58% overall saying they had been sexually harassed.
Physicians Get Brunt of Inappropriate Communication
Physicians, however, were the most likely to report that a patient had tried to communicate with them in an inappropriate manner, either online or with social media. Among physicians, 39% said they had experienced such attempts, compared to 22% of nurses.
Those percentages were similar among genders: 40% of female physicians vs 39% of male, and 22% of female nurses vs 27% of male reported such communication.
Almost all male nurses (96%) and 84% of female nurses said they had been physically threatened. For physicians, the percentages were 61% for men and 63% for women.
A physician who commented on the poll story wrote, "I have been thrown against the wall resulting in a cracked rib (I am 6-1 and 200 lbs and strong...but the patient was bigger and stronger.)"
Hit, Kicked, Threatened
A woman who said she has been a nurse practitioner for 19 years and a registered nurse for 40 years after she had been a nurse's aide said, "I have been bit, and hit and kicked when younger. More recently, verbal abuse has seemed to greatly increase in frequency. The majority of the time, it has been related to refusing to continue pain meds or benzos. I had one patient, whom I had refused to give cough medicine with narcotic in it, threaten me by saying, 'What will you think if I show up in your driveway at midnight if I can't quit coughing?' "
Harassment seemed to decline in the survey among physicians who had 21 or more years of experience, but it remained fairly consistent for nurses at all levels, with the exception of online communications, which dropped for those who had 10 years of experience.
Table. Harassment by Years of Experience
Physician Years of Practicing Nurse/Advanced Practice Nurse Years of Practicing
1 - 10 11 - 20 21 and up 1 - 10 11 - 20 21 and up
Percentage who say they were sexually harassed by a patient
53.% 58.% 40.% 74.% 70.% 70.%
Percentage who report patients have tried to communicate with them inappropriately online or through social media
46% 58% 30% 35% 19% 19%
Percentage who report a physical threat from a patient
62% 72% 58% 85% 88% 84%
Although the prevalence of patient harassment has not been well studied, a meta-analysis in the Journal of the American Academy of Psychiatry and the Law in 2015 speculated that the prevalence could be as high as 20%.
Several commenters referenced drug dependency as the impetus for threats and violence.
An emergency medicine physician mentioned the worry, particularly among emergency department providers, after Todd Graham, MD, a physiatrist in South Bend, Indiana, was gunned down in an emergency department parking lot in August last year by a disgruntled drug-seeking patient, a case previously reported by Medscape Medical News.
"One always wonders about going out to our cars after run-ins of this nature," the commenter wrote. "I personally think every big city ER should have an armed guard or police officer present...but...resources and funds don't allow it.' "
He added, "The problem is becoming increasingly worrisome and prevalent now as we (finally!) try to stem the unconscionable flow of narcotics from our ER's. Be careful out there...."
Change will be needed on several fronts, the medical community agrees.
For example, a recent article published in Academic Medicine, which was reported by Medscape Medical News, urges medical institutions to establish zero-tolerance policies against sexual harassment, along with the protocols to enforce that policy.
Marcia Frellick
February 01, 2018
