Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20181381Keywords:
Violence against doctors, Health care work place violence, Perception, Qualitative study, Junior doctors, IndiaAbstract
Background: Health care work place violence (HCWPV) is four times higher compared to violence against other professions. The problem remains under-reported and under-researched. Qualitative perception studies among junior doctors have not been paid due attention hitherto.
Methods: Six individual face-to-face-indepth-interviews and six focus-group-discussions were conducted during December 2017 and January 2018 among 41 young doctors (interns, resident doctors i.e. post graduate students and young clinical faculty members). Thematic (content) analysis method was used for analysis of the data (texts).
Results: Relevance, causes as well as consequences of HCWPV and measures for its prevention and control were brought up and discussed. Four themes emerged in thematic analysis. Almost all of the participants believed that it is an extremely important topic. Causation is multifactorial whereby all stakeholders are responsible. Consequences are affecting the whole society not merely the victims. Measures suggested were related to - in view of the causes - medical profession; patients and society; behavior and process; system and administration.
Conclusions: Increasing materialism and eclipse of humanitarian values, media-created-violence, negative image of medical profession, patient-physician-distrust, zero-protection for doctors, apathetic governments and deficiencies in the process of justice are among the main causes of HCWPV. Junior doctors were not much optimistic of any improvement in near future in their safety and security as this would require more probity and unity among doctors and a clientele, a Health Care Delivery System, the Governments and a Judiciary much different from what it is today.
References
Occupational Safety and Health Administration (OSHA) US Dept of Labour. Fact sheet: workplace violence in healthcare, 2015. Available at: https://www.osha.gov/dsg/hospitals/workplace violence.html. Accessed on 4 December 2017.
Nelson R. Tackling violence against health-care workers. Lancet. 2014;383(9926):1373-4.
Indian Medical Association Press Release. Majority of doctors fear violence and are stressed out reveals IMA study. 2017. Available at: http://emedinews.in/ ima/Press_Release/2017/July/1.pdf. Accessed on 4 December 2017.
Gates D. The epidemic of violence against healthcare workers. Occupational and Environmental Medicine. 2004;61(8):649-50.
Nagpal N. Incidents of violence against doctors in India: Can these be prevented? Natl Med J India. 2017; 30:97-100.Nagpal N. Incidents of violence against doctors in India: Can these be prevented? Natl Med J India. 2017;30:97-100.
Ahmed F, Khizar Memon M, Memon S. Violence against doctors, a serious concern for healthcare organizations to ponder about. Annals of Medicine and Surgery. 2018;25:3-5.
Hobbs FD, Keane UM. Aggression against doctors: a review. Journal of the Royal Society of Medicine. 1996;89(2):69-72.
Hobbs FD. Violence in general practice: a survey of general practitioners’ views. Br Med J.1991;302(6772):329-32.
Jones A. The violence of materialism in advanced industrial society: an eco-sociological approach. The Sociological Rev. 1987;35:19–47.
Ambesh P. Violence against doctors in the Indian subcontinent: A rising bane. Indian Heart J. 2016;68(5):749-50.
Kapoor MC. Violence against the medical profession. J Anaesthesiol, Clin Pharmacol. 2017;33(2):145-7.
Syed MMA. Violence against healthcare professionals: are we looking for the peaceful truce? Int J Stud Res. 2016;6(1):1-2.
Anand T, Grover S, Kumar R, Kumar M, Ingle GK. Workplace violence against resident doctors in a tertiary care hospital in Delhi. Natl Med J India. 2016;29(6):344-8.
Kumar M, Verma M, Das T, Pardeshi G, Kishore J, Padmanandan A. A Study of Workplace Violence Experienced by Doctors and Associated Risk Factors in a Tertiary Care Hospital of South Delhi, India. J Clin Diagnos Res. 2016;10(11):6-0
Mirza NM, Amjad AI, Bhatti AB, tuz Zahra Mirza F, Shaikh KS, et al. Violence and abuse faced by junior physicians in the emergency department from patients and their caretakers: A nationwide study from Pakistan. J Emerg Med. 2012;42:727–33.
Yu H, Hu Z, Zhang X, Li B, Zhou S. How to overcome violence against Healthcare professionals, reduce medical disputes and ensure patient safety. Pakistan J Med Sci. 2015;31(1):4-8.
Zhao S, Liu H, Ma H, Jiao M, Li Y, Hao Y, et al.Coping with Workplace Violence in Healthcare Settings: Social Support and Strategies. Watterson A, ed. Int J Environ Res Public Health. 2015;12(11):14429-44.
Chinese doctors are under threat. Lancet. 2010;376(9742):657.
Violence against doctors: Why China? Why now? What next? Lancet. 2014;383(9922):1013.
Wu D, Wang Y, Lam KF, Hesketh T. Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open. 2014;4:e006431.
Z Chen, C Peek-Asa, G Yang. Prevalence of and risk factors associated with workplace violence: a cross-sectional study in 7026 health staff in South China. Inj Prev. 2010;16:4.
Xing K, Zhang X, Jiao M, Cui Y, Lu Y, Liu J, et al. Concern about Workplace Violence and Its Risk Factors in Chinese Township Hospitals: A Cross-Sectional Study. Tchounwou PB, ed. Int J Environ Res Public Health. 2016;13(8):811.
Sun T, Gao L, Li F, Shi Y, Xie F, Wang J, et al. Workplace violence, psychological stress, sleep quality and subjective health in Chinese doctors: a large cross sectional study. BMJ Open. 2017;7:e017182.
Sun P, Zhang X, Sun Y, Ma H, Jiao M, Xing K, et al. Workplace Violence against Health Care Workers in North Chinese Hospitals: A Cross-Sectional Survey. Mawson AR, ed. Int J Environ Res Public Health. 2017;14(1):96.
Shi J, Wang S, Zhou P, Shi L, Zhang Y, Bai F, et al. The Frequency of Patient-Initiated Violence and Its Psychological Impact on Physicians in China: A Cross-Sectional Study. PLoS ONE. 2015;10(6):e0128394.
Jiao M, Ning N, Li Y, Gao L, Cui Y, Sun H, et al. Workplace violence against nurses in Chinese hospitals: a cross-sectional survey. BMJ Open 2015;5:e006719.
Zhou C, Mou H, Xu W, Li Z, Liu X, Shi L, et al. Study on factors inducing workplace violence in Chinese hospitals based on the broken window theory: a cross sectional study. BMJ Open. 2017;7:e016290.
Shi L, Zhang D, Zhou C, Yang L, Sun T, Hao T, et al. A cross–sectional study on the prevalence and associated risk factors for workplace violence against Chinese nurses. BMJ Open. 2017;7:e013105.
Cheung T, Lee PH, Yip PSF. Workplace Violence toward Physicians and Nurses: Prevalence and Correlates in Macau. International J Environmental Res Public Health. 2017;14(8):879.
Li Z, Yan C-m, Shi L, Mu H-t, Li X, Li A-q, et al. Workplace violence against medical staff of Chinese children's hospitals: A cross- sectional study. PLoS ONE. 2017;12(6):e0179373.
Okeke SO, Mabuza LH. Perceptions of health care professionals on the safety and security at Odi District Hospital, Gauteng, South Africa. African J Primary Health Care Family Med. 2017;9(1):1441.
Sisawo EJ, Ouédraogo SYYA, Huang S-L. Workplace violence against nurses in the Gambia: mixed methods design. BMC Health Services Res. 2017;17:311.
Terry D, Lê Q, Nguyen U, Hoang H. Workplace health and safety issues among community nurses: a study regarding the impact on providing care to rural consumers. BMJ Open. 2015;5(8):e008306.
Vorderwülbecke F, Feistle M, Mehring M, Schneider A, Linde K. Aggression and Violence Against Primary Care Physicians—a Nationwide Questionnaire Survey. Deutsches Ärzteblatt Int. 2015;112(10):159-65.
Schablon A, Zeh A, Wendeler D, Peters C, Wohlert C, Harling M, Nienhaus A, et al. Frequency and consequences of violence and aggression towards employees in the German healthcare and welfare system: a cross sectional study. BMJ Open. 2012;2(5):e001420.
Johansen IH, Baste V, Rosta J, Aasland OG, Morken T. Changes in prevalence of workplace violence against doctors in all medical specialties in Norway between 1993 and 2014: a repeated cross sectional survey. BMJ Open. 2017;7:e017757.
Bayram B, Çetin M, Çolak Oray N, Can İÖ. Workplace violence against physicians in Turkey’s emergency departments: a cross sectional survey. BMJ Open. 2017;7:e013568.
Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Educ Today. 2004;24(2):105–12.
Joshi SC, Diwan V, Tamhankar AJ, Joshi R, Shah H, Sharma M, et al Qualitative study on perceptions of hand hygiene among hospital staff in a rural teaching hospital in India. J Hosp Infect. 2012;80(4):340-4.
Joshi SC, Diwan V, Tamhankar AJ, Joshi R, Shah H, Sharma M, et al. Staff Perception on Biomedical or Health Care Waste Management: A Qualitative Study in a Rural Tertiary Care Hospital in India. Griffiths UK, ed. PLoS ONE. 2015;10(5):e0128383.
Tucker JD, Cheng Y, Wong B, Gong N, Nie JB, Zhu W, et al. Patient physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study. BMJ Open. 2015;5(10):e008221.
Morken T, Johansen IH, Alsaker K. Dealing with workplace violence in emergency primary health care: a focus group study. BMC Family Practice. 2015;16:51.
Tian J, Du L. Microblogging violent attacks on medical staff in China: a case study of the Longmen County People’s Hospital incident. BMC Health Services Res. 2017;17:363.
Fernandes CM, Raboud JM, Christenson JM, Bouthillette F, Bullock L, Ouellet L, et al. Violence in the Emergency Department Study (VITES) Group. The effect of an education program on violence in the emergency department. Ann Emerg Med. 2002;39(1):47-55.
Bawaskar HS. Violence against doctors in India. Lancet. 2014;384(9947):955 6.
Begum S, Khowaja SS, Ali G. Media created violence: a social determinant of mental health J Pak Med Assoc. 2012;62(12):1338-40.
Khawaja A, Irfan H.Violence against doctors in government hospitals and the role of media. J Pak Med Assoc. 2011;61(11):1163-4.
Jawaid SA. Prevention and intervention strategies to check increasing violence against Healthcare Facilities and Healthcare Professionals. Pak J Med Sci. 2016;32(1):1-2.
Kane S, Calnan M. Erosion of Trust in the Medical Profession in India: Time for Doctors to Act. International J Health Policy Management. 2017;6(1):5-8.
Bal A. A doctor's murder. Issues in Medical Ethics. 2001;9(2):39.
Pai SA. Violence against doctors on the increase in India. Natl Med J India. 2015;28(4):214-5.
Nagral S. Doctors and violence. Indian J Med Ethics. 2001;9(4):107.
Supe A. Violence against doctors cannot be tolerated. BMJ opinion. March 29, 2017. Available at: http://blogs.bmj.com/bmj/2017/03/29/avinash-supe-violence-against-doctors-cannot-be-tolerated/. Accessed on 4 December 2017.
Mishra S. What ails the practice of medicine: The Atlas has shrugged. Indian Heart J. 2015;67(1):1-7.
Mishra S. Violence against Doctors: The Class Wars. Indian Heart J. 2015;67(4):289-92.
Kar SP. Addressing underlying causes of violence against doctors in India. Lancet. 2017;389(10083):1979-80.
Mohamed R. Violence against healthcare personnel in Libya. Ibnosina J Med Biomedical Sci. 2014;6(1):44-6.