Doctors decide: Beat the bullies
7 July 2014
We asked you how bullying by patients made you feel. The Doctors Decide panel gives its reaction
Have you ever been bullied by a patient at work?
Some of your views:
Yes: ‘Demanding treatments, insisting on everything happening “now” and threatening complaints and repercussions are an increasing challenge.
‘It is propagated by a culture of wanting more for less, fuelled by media-fed misinformation. Patients need to be better informed about the true costs and challenges of providing healthcare in a cash-starved NHS.’
Oxford ST2 (specialty trainee 2) in general surgery Kunal Kalkurni
Yes: ‘Patients can feel vulnerable and scared when confronted by a hospital or a doctor. They can be confused by terminology and in pain. Some are intoxicated. All deserve our best clinical care.
'While physical and verbal bullying of staff by a patient can never be tolerated we must do everything we can as professionals to de-escalate situations. Sometimes this means walking away, a cup of tea for both parties and trying to engage the patient in communication again later.’
Bristol ST7 in acute internal medicine Nigel Lane
Yes: ‘I remember one patient who was aggressive and abusive and rude through no fault of my own. I was on my own with the patient and their partner. I kept calm and walked out to get a nurse who took the couple out to talk to them and she explained that such behaviour was not acceptable. There have been other incidences.
‘I do think that your colour and status makes a difference to how patients behave towards you. I know of incidences where my white male colleagues were blunt with patients but no one complained about them. If I behave in such a fashion (not that I would ever want to) I would never get away with this.
Yes: ‘While working in a busy emergency department, getting threatened by patients and relatives who felt your answers weren’t what they wanted to hear isn’t unusual. Getting the occasional punch thrown at you (fortunately missing), sworn at and occasionally having after-work threats was all in a day’s work for the entire team, from nurses to doctors, support staff to radiographers and, of course, the security team.’
Manchester ST1 in paediatrics Latifa Patel
Yes: ‘Patients bully doctors regularly in getting their way. Too often, we give in because a complaint, however unjustified, is damaging and can cause misery and heartache for months or years. It is easier to give in as long as it is not illegal. You may fret for a while, but this passes.’
No: ‘The bullying that takes place in the NHS is of doctors by managers, or more often doctors by other doctors more senior to them.’
Yorkshire associate specialist in trauma and orthopaedics Rodney Price
Have you ever reported an incidence of bullying of a doctor, either yourself or a colleague, by a patient?
Some of your views:
Yes: ‘It is not so often that the patient themselves do the bullying in emergency departments but their relatives.’
London specialty doctor in emergency medicine Cathryn Wield
No: ‘Unrealistic demands by patients not in line with accepted clinical practice can come across as bullying. This is difficult to get around but having conviction of your views can help in bringing them around to the right course of action.’
Merseyside consultant general surgeon Shabbir Poonawala
Yes: ‘I am in a position of advising doctors and overseeing and managing incidents raised, so I see this frequently.
‘Doctors are often bullied by other staff including other doctors or nurses. While the stereotype is of junior doctors being bullied by seniors, I also come across senior doctors being remorselessly bullied by juniors.'
Do you think more should be done to tackle bullying of doctors by patients?
Some of your views:
Yes: ‘I have definitely worked in a team that a family seemed to be bullying, through unreasonable demands in terms of unavailable or inappropriate treatment and repeated requests for team members to devote long periods of time going over the same conversation about the patient’s management. I have also seen general threatening where if what they wanted didn’t happen, there would be a large-scale complaint to contend with.
‘This struck me as very problematic because ultimately their loved one received poorer care because our attention was deflected from the patient on to family members and the care of other patients managed by the team suffered as a result of the drain on our time.’
London foundation doctor 2 Roxanne Keynejad
No: ‘Doctors are by definition in a position of power in relation to patients. There are some patients who can be very difficult to deal with. It is part of being a professional that one can deal with such difficult individuals.
‘Unfortunately, this is an issue for society in general, as toxic individuals will always be with us. Dressing this up as bullying, and by extension some else’s problem is not a professional way of dealing with it.’
Hampshire retired consultant in public health David Hewett
Yes: ‘Sometimes, it’s not the patients but their relatives who make it difficult for all staff, not just doctors. I have had patients apologise because of their relatives’ behaviour but no one can actually challenge or stop this as they stop short of verbal or physical abuse.
'These same relatives then sometimes make lots of complaints to the Patient Advice and Liaison Service, generating more work.‘Staff are not perfect and I am sure we are not brilliant all the time. However, there doesn’t seem to be any protection for staff from the behaviour of such people.
Yes: ‘It’s a growing menace really, and juniors are most at risk. We always fear a GMC referral if we don’t capitulate — where is the guidance from the GMC or support from our seniors?
‘Is this a societal phenomenon, a reaction by the poorest to their services being squeezed, or are we doctors doing something wrong? Anything that leads to bad medicine needs to be dealt with — let’s look at this now.’
BMA junior doctors committee joint deputy chair Tim Yates
Find out more about how the BMA can help with emotional problems