Get out of my Emergency Department

It is not uncommon to hear about the abuse of doctors and nurses in emergency departments around the world.  You have a group of professionals whose primary role is to help people and they are subjected to both verbal and physical abuse.

In my time working in emergency departments I encountered this type of abuse.  This did not only come from those patients who were in the department for mental health reasons, but from all kinds of patients and their families.

Health professionals have a legal obligation for the care of their patients.  If a patient presents to the emergency department and we fail to treat and this leads to poor outcomes we are at risk of being sued, losing our right to practice medicine or in extreme cases legal charges.  It seems that we provide a service but we cannot choose not to treat someone because we are legally responsible.

I find this more than odd.  For example, if you need to change a tyre on your car, you go to a mechanic for a service.  If you abuse the mechanic verbally or physically not only can they refuse to serve you but they can call the police.  Now if you then drive away and have a devastating car accident because of the tyre that was not changed, is the mechanic responsible? Or are you responsible?  In this situation it seems quite clear that you are responsible, no one should have to tolerate abuse.  Then why do we put so much responsibly on doctors?

Ok, so what about mental health? Where people have mental health conditions and are in situations of severe paranoia or mania.  In these situations doctors need more freedom to restrain and administer medications for the patients and staff own safety.  We put so much pressure on doctors not to restrain or use medication in these situations and this often comes at a detriment to staff, placing them in dangerous situations including death.  If a patient is abusive and it is not solely a mental health problem (many patients who abuse staff often do have some kind of mental health problem, but this is not the main reason for their abuse) we as doctors should be able to refuse treatment, just like the mechanic.  Doctors provide a service and in any other industry abuse would not be tolerated. We have a duty to serve the public but not at the expense of verbal or physical abuse.

There have been many reports of fatal stabbings; gunshot wounds, fatal beatings in both hospitals and General Practice clinics, sometimes simply because a patient was not prescribed the drugs they wanted.  A recent example was a patient holding surgical scissors to a doctor’s throat and a non fatal shooting of a security guard (that lead to emergency surgery and an ICU admission) in an emergency department, after the incident the patient was deemed not fit to be in police custody and was returned for treatment to that same hospital emergency department.  This patient was an ice addict.  Those staff should have the right to refuse to treat that patient to protect themselves, even if it leads to that patients harm or death.  How much responsibility do we need to take for other people’s poor decisions or their mental health conditions? Why should we have to tolerate such nonsense and endanger our lives?  If you abuse a doctor, a nurse or anyone in the medical profession you should be refused treatment or you should be sedated/retrained. That is the harsh reality.  Doctors and nurses should not have to fear for their lives from the same people they are trying to help.

-The Doctor

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