Reassessment of violence toward emergency medicine physicians in Michigan

Hamzeh Omar ^a,?, Rebecca Yue ^a, Amanda Amen ^a, Terry Kowalenko, MD ^b, Bradford L. Walters, MD ^c

^a Oakland University William Beaumont School of Medicine, Rochester, MI, United States of America

^b Department of Emergency Medicine, Medical University of South Carolina, United States of America

^c Department of Emergency Medicine, Beaumont Health System, United States of America

a r t i c l e i n f o

Article history:

Received 16 May 2019

Received in revised form 29 August 2019

Accepted 3 September 2019

Keywords:

Violence Emergency

Physician workplace Department

Dear Editor:

workplace violence is commonplace in our society and within the healthcare system. The emergency department (ED) is where such inci- dents happen most frequently. In 2005, members of the Michigan Col- lege of Emergency Physicians were surveyed to assess the incidence of four types of workplace violence: verbal threats, physical assault, con- frontation outside of the ED visit, and stalking [1]. In 2018, we dupli- cated that survey to ascertain any changes in the experiences that might have occurred over 13 years with one additional category that did not exist in 2005: violence through social media/Satisfaction surveys.

Workplace violence continues to be a frequent occurrence in the ED as the overall incidence did not significantly change from 2005 to 2018 (76% vs. 72.4%). The incidence of verbal threat, confrontation outside of the ED interaction, and stalking were unchanged. However, physical as- sault was more common with an increase from 28.1% to 38.1% (p = 0.01). We found that social media or satisfaction surveys were not a major source of ED violence (6.3% and 17.9% respectively). The impact of ED workplace violence took a number of forms. Physicians reported being more constantly or frequently afraid of being a victim (1% to 8% and 9% to 22% respectively; p b 0.001). As compared to 2005, emergency physicians consistently acquired forms of personal protection. While

* Corresponding author at: 44701Fenwick Drive, Canton, MI 48188, United States of America.

E-mail address: [email protected] (H. Omar).

this survey showed that the fear of being a victim has increased over the years, fewer physicians indicated an inclination to leave their cur- rent position (16% to 8.6%; p = 0.02). Hospital administrative support of emergency physicians who are victims of workplace violence is lack- ing as only 17.5% reported such incidents to their supervisors.

Our data supports the conclusion that workplace violence continues to be a part of the practice of emergency medicine. Verbal threats are the most common form of such violence and did not change in the past 13 years. It is distressing to see that the incidence of physical as- saults seems to be increasing, likely mirroring our society in general. The stress on individual physicians is considerable with the fear of be- coming a victim increasing among our survey respondents. One can log- ically conclude that workplace violence in the ED can only contribute to the alarmingly high rate of reported burnout in emergency physicians. In addition, it appears that the healthcare system and direct supervisors of the ED have done a poor job in supporting their physician staff as few emergency physicians report such incidents. Clearly, further research is necessary to explore the complex facets and impact of workplace vio- lence in the ED to assure the safety and wellbeing of the physicians who practice in that environment. The status quo of complacency, ac- ceptance that workplace violence is part-in-parcel to the practice of emergency medicine, and desensitization is not acceptable. We encour- age our fellow emergency physicians to voice their concerns about this problem within their hospital, their state, and nationally so that the fol- lowing experience of one such physician becomes a rarity:

“I saw a patient standing, with the blood pressure machine cord wrapped around a nurse’s neck, using both hands to tighten it. She looked terrified. I ran toward him and tackled him. The nurse had neck abrasions but did not require treatment. We were all traumatized by this incident, and even more so by the very slow way this went through the courts.” [~Anonymous Michigan emergency physician reported to the American

College of Emergency Physicians.]

Meetings

ACEP Research Forum, San Diego, CA. October, 2018.

AMA Research Symposium, National Harbor, MD. November, 2018.

https://doi.org/10.1016/j.ajem.2019.158427

0735-6757/(C) 2019

H. Omar et al. / American Journal of Emergency Medicine 38 (2020) 1582-1583 1583

Oakland University Graduate Student Research Conference, Roches- ter, MI. March, 2019.

Grants

This project did not receive financial support.

Author contributions

BLW and TK conceived of the study, designed the survey, and ob- tained research funding for the original study in 2005. HO, RY, AA, and BLW conceived the current study, designed the electronic survey, and

performed data collection. HO and RY drafted the manuscript, and all authors contributed substantially to its revision. HO takes responsibility for the paper as a whole.

Declaration of competing interest

No disclosures.

Reference

[1] Kowalenko T, Walters BL, Khare RK, et al. Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005;46(2):142-7.