A study conducted by researchers at the University of California—San Francisco School of Medicine recently featured in the Los Angeles Times suggests that patient-initiated assaults are a growing problem in many hospitals, particularly in emergency rooms and psychiatric wards.
As a medical student, how would this affect you?
Unfortunately, many of the instances reported in this study and others conducted in the past say that the first points of contact—typically nurses—bore the brunt of the assaults reported. Medical students are often the first point of contact for many patients at teaching hospitals. One study in the Journal of the American Medical Association (JAMA) reported that 16 percent of a third-year medical school class surveyed reported being subjected to physical assaults.
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The reality is that healthcare workers face up to five times the risk of assault as other fields, placing it on par with the mining industry in terms of occupational health risk. There are a multitude of reasons triggering this phenomenon: Patients can feel less inhibited in a hospital setting; they may suffer from illness or drug use; they could already be predisposed to violence; or they simply feel frustrated with growing wait times plaguing emergency rooms around the country.
Because all trainees—medical students and most residents—must complete some of their training in the ER or a psychiatric ward, it is important to be aware of this risk. A study posted in Academic Psychiatry reported that 29 percent of internal medicine and 20 percent of surgical trainees experienced some form of physical assault during their training.
The study noted that many assaults went unreported to hospital administrators due to self-blame and a perception that it's "part of the job description." In the JAMA survey, assaults, and a perceived lack of support around them, were a key reason that led approximately one third of medical students to avoid certain clinical rotations or even question their career choice.
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Thankfully, there is some good news: Medical schools and hospitals have been taking steps to address the seemingly high level of assaults.
• Increased security: Some hospitals, particularly in urban areas, have introduced airport-style security to protect patients and staff. For example, Los Angeles County/USC Medical Center introduced this type of security, complete with armed police officers, in the early 1990s after an attack on three staff members in their ER.
• Introduction of awareness and defense training: Many medical schools have incorporated training in their curricula to try to reduce the risk of assault. Often, these include reviewing the risk factors and predictors for violent behavior, reviewing protocols for reporting, and offering support systems for those who suffered from an assault.
There are also some important steps you can take when researching schools:
• Make sure schools have a mechanism for dealing with assaults on students: When researching and visiting schools, many schools—especially those in larger urban areas—will offer information on steps they have taken to ensure students' safety. However, since assaults can happen anywhere, it's important to ask what the school is doing to protect their students on clinical services.
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• Ask a current student: While information directly from the school is helpful, if you're really interested in a particular school, nothing beats feedback directly from current students. They're in the trenches, and they are usually honest to prospective students about how they feel about their safety.
Whatever you decide for your medical career, it is important to be aware of this growing trend and what is being done to protect trainees and staff. Unfortunately, a career in medicine can sometimes involve working in a potentially dangerous environment. Though it probably seems far off for many of you, it's important to not only ensure steps are taken to prevent assaults, but also to have resources to help those who have had the misfortune of being the victim of an attack.
Ibrahim Busnaina, M.D. is a graduate of the University of Pennsylvania School of Medicine and coauthor of "Examkrackers' How To Get Into Medical School." He has been consulting with prospective medical school applicants, with a special focus on minority and other nontraditional candidates, since 2006.