Is enough done to deter violence in general practice?


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One encounter with an aggressive patient and the ensuing consequences were enough for a general practitioner to consider retiring from the profession.

dr  Alvin Chua

dr Alvin Chua has described a violent incident at his family doctor’s office as “the last straw”.


The pandemic has put many societal issues in a harsh light, including the potential for violence against healthcare professionals.


GP teams, particularly in clinics offering COVID-19 vaccinations, “have often been the target of patient frustration and sometimes aggressive behavior,” reported a RACGP filing with Australia’s National Audit Office last year.


But the issue was certainly not limited to those attending the rollout – as Adelaide-based GP Dr. Alvin Chua knows all too well.


A violent encounter at his GP practice in the early stages of the pandemic pushed him from his job.

 

He says the incident happened after he intervened when a man entered the practice and started using racial slurs against a receptionist. dr Chua describes being pushed backwards by the man, losing his footing and shaking his back.

It solved for Dr. Chua unveiled a deeply disturbing chain of events, including the discovery of a pre-existing spinal stenosis and ossification of the posterior longitudinal ligaments.

A cadaver bone graft was performed, which subsequently crumbled, and another operation followed, inserting two rods and 10 screws into his spine. dr Chua said he felt pain like he had never felt before.

Myelomalacia of his spine at chest level was also discovered following a thoracic laminectomy and he continues to suffer from severe discomfort.

“Maybe he did me a favor, maybe he didn’t, but at the end of the day it was the drop that broke that camel’s back,” he said NewsGP.

The rise in violence against healthcare professionals is by no means unique to Australia.

In May 2020, the World Medical Association described it as “an international emergency” and said the problem had escalated over the past decade and then “expanded dramatically” as COVID-19 spread.

Research based on meta-analysis and systemic reviews conducted prior to the pandemic found that 61.9% of healthcare participants had been exposed to some form of workplace violence, including non-physical abuse.

More specifically in terms of general practice, a study published in the British Medical Journal reported a steep increase in incidents in April compared to previous years, including physical violence.

Using freedom of information requests sent to police forces across the country, investigators found 1,068 incidents of violence at UK health centers and GP surgeries in 2021-22 – including 182 that resulted in injuries.

The figures were described by a British GP as “the tip of a much, much bigger iceberg”.

But it wasn’t just the violence that Dr. Chua found discouraging.

dr Chua is also deeply disappointed with the police response to the attack on the general practice as no charges were filed despite an affidavit.

At the same time, he had to deal with a notification from the Australian Health Practitioner Regulation Authority (AHPRA) triggered by the man who assaulted him, which he learned about on the day of his first surgery. It was only dismissed unscathed on the day he had his second operation.

“It made me quit my job,” said Dr. Chua.

dr Cameron Loy, a former RACGP Victoria Chair and recipient of the RACGP Rose Hunt award, is another family doctor who has been attacked on duty – once in the GP’s office and once while working in a hospital.

he understands dr Chua’s rage.

“What happened to Alvin is terrible,” he said NewsGP. “It should never have happened. His complaint that the system failed to protect him is entirely valid.’

dr Loy says GPs mostly do their jobs without a hitch – but that violence in the GP office is “not new”.

“The data suggests it’s very common and violence isn’t just physical,” he said. “There is verbal and other forms of violence that occur in general medical offices.”

dr Loy believes there is reason for reform because many healthcare workers — as was the case with Dr. Chua was the case – noting that incidents are not heard by the courts.

“I know that was the case in my cases,” he said.

“The appetite for it and how you affect that change is a much, much harder question.”

He believes part of the answer lies in how the courts, police and community perceive aggression towards doctors and other healthcare workers.

“I want Mrs. Smith down the street to be as angry that Alvin Chua was attacked as I am,” he said. “But I don’t know if she even knows about it.”

The legal background

It can be difficult to undo the different legislative approaches when it comes to criminal laws that are specific to each state.

A further complication is that GP practices are classified as small businesses, while in some cases government-employed healthcare workers can – at least in the letter – be given more protection from attacks.

dr Well aware of the differences, Chua lashes out at a recent NSW bill that would see tougher penalties for assaults on hospital workers and pharmacists, but not GPs.

As recently highlighted in The Doctors’ Republic, a 2020 report by the NSW Sentencing Council looking at violent crimes against rescue workers, endorsed the case for tougher punishment for assaults on hospital workers. The report did not have the same view of general practice.

“We have received no evidence that assaults on medical staff in other healthcare settings, such as general practice clinics or community health clinics, are a particular problem,” the report said.

“We have no evidence to justify the extension of the new crimes to these locations.”

Whilst this report did not make reference to pharmacists as part of the definition of frontline health workers, the bill submitted to NSW Parliament does – and omits GPs.

Submissions to the Judgment Council from other organizations also reflect some of Dr. Loy’s nuances and complexities.

The NSW Young Lawyers argued that the definition of health workers should be broader, while the Law Society of NSW claims that “a reasonable range of offenses and penalties” already exists and that there would be “limited benefits” in changing the maximum penalties .

AMA NSW claimed that a compulsory conviction would limit a judge’s “discretionary power to consider mitigating factors”. It could also “disproportionately affect those who are already over-represented in the prison system, such as Aboriginal and Torres Strait Islander people,” argues their bill.

An article has since appeared frontiers in public health Journal in 2020 says evidence on the effectiveness of such interventions is “still lacking.”

‘[Healthcare workers] around the world generally advocate tougher laws, but harsher penalties alone are unlikely to solve the problem,” the report said.

However, its authors recommend a firm stance against acceptance.

“The notion that violence is inherent in the work of doctors and nurses, particularly in certain departments, needs to be challenged,” they wrote.

“Urgent action must be taken to ensure the safety of all healthcare workers in their local area and the necessary resources must be allocated.

“If they don’t, the care they are used to provide will be degraded and will ultimately have a negative impact on the entire healthcare system worldwide.”

dr Loy also insists that the kind of incidents he shared with Dr. Chua and so many others, should never be seen as “just part of the job”.

“Is violence a feature of our society? Yes. Humans are a violent species. I think we have a whole development demonstrating that,” he said.

“Should it just be an integral part of the work in medicine? No it shouldn’t.

“I do not go to work to be verbally or physically attacked by patients or their families.

“We should never accept it, there should be absolutely no tolerance for it.”

The RACGP makes the following resource available to members Dealing with patient aggression.



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