ED doctors on receiving end of threats, violence

Emergency physicians face perhaps the greatest likelihood of violent encounters with patients. But internists, surgeons and others are not immune.

By Damon Adams, AMNews staff. March 7, 2005.

A man high on cocaine punched four people in a Michigan emergency department before a doctor intervened and the unruly patient slugged him twice in the face.

The emergency physician needed eight stitches to close his gashed forehead. The patient spent the night in jail.

The scuffle was recalled by an anonymous emergency physician who participated in a new study on violence in emergency departments in Michigan. The study, released online last month by the Annals of Emergency Medicine, found that 76% of the 171 emergency physicians in the survey reported experiencing at least one violent act the previous year.

Three in four respondents to the 2002 questionnaire reported verbal threats, while 28% said they were victims of physical assaults. Nearly 12% were confronted outside the ED and 3.5% were stalked. The acts prompted 42% of the doctors to seek protection, including 18% who obtained a gun and 20% who bought a knife.

Although the survey involved only Michigan, the study's lead author and other physicians said violence occurs in emergency departments nationwide. "I have no doubt that this is a global problem," said lead author Terry Kowalenko, MD, program director of the emergency medicine residency program at University of Michigan/St. Joseph Mercy Hospital in Ann Arbor, Mich.

Medical leaders say emergency physicians face perhaps the greatest likelihood of violent encounters with patients because of their volatile work environment. Police and other personnel often bring violent patients to their departments, and the doctors often deal with intoxicated patients and their families.