From burnout to bullying: Understanding Why Patients Harass Doctors

Introduction

The valiant guardians of our well-being, health workers, constantly face a grave danger lurking in the shadows – violence. Shockingly, the World Health Organization has reported that a staggering 8% to 38% of these brave souls have been physically harassed during their careers, while countless others have been subjected to the harrowing experience of verbal aggression and threats. Patients and visitors, the very people they strive to heal, are often responsible for this malevolent behavior. But the threat doesn’t stop there – in times of disaster or conflict, health workers may also become targets of collective or political violence¹.

What Are the Most Common Patient Harassing Behaviors?

Although the pandemic has intensified the issue, the reality is that doctors have been subjected to harassment by their patients for quite some time now, and this continues to be a growing concern. Shockingly, healthcare professionals are also at risk of being stalked by their patients, with prevalence rates ranging from 6% to 53%, as reported in a recent study². The problem doesn’t end there – sexual harassment is also alarmingly common. A 2020 study surveyed 6,235 healthcare providers and revealed that 27% of physicians had been sexually harassed by patients³.

Physicians frequently encounter a range of other problematic patient behaviors, some of which may reflect underlying mental health issues. Let’s take a closer look at five such behaviors³.

Illness Anxiety Disorder^1-4

Illness anxiety disorder patients tend to visit or call their doctors for every ailment due to their constant worry over symptoms and care. When their needs aren’t met, they can become fearful and angry, feeling neglected. However, a referral isn’t the only way to treat such patients.

The Primary Care Companion to the Journal of Clinical Psychiatry published a study suggesting the following recommendations:

• Establish a collaborative relationship with the patient to understand their perspective.
• Assess if the patient is experiencing other psychiatric disorders, such as anxiety or depression.
• Differentiate the patient’s personality traits from their abnormal illness beliefs.
• Address the patient’s psychosocial issues rather than just their health concerns.

Flirting With the Physician^1,5

Some patients tend to compliment their physicians on their appearance persistently or make romantic advances by engaging in flirtatious conversations, sometimes even crossing subtle boundaries.

The following approaches can be followed when dealing with inappropriate behavior from patients:

• Establish clear rules and boundaries at the outset of the doctor-patient relationship.
• Conduct physical contact solely for medical examinations.
• Redirect the patient if they attempt to overstep the boundaries.
• Have a colleague present during appointments with the patient.
• Only see the patient in the office.
• Record the behavior if it persists over time.
• Refer the patient to a mental health professional if a behaviour change suggests psychiatric intervention is necessary.

Verbal Abuse or Threats⁵

A patient’s anger can stem from discomfort, pain, or dissatisfaction with their medical condition. In such cases, the patient might resort to making verbal threats or being abusive toward their physician.

Consider the following measures when dealing with an angry patient:

• Stay composed and avoid using aggressive language, even if the patient is doing so.
• Convey a composed and compassionate demeanor.
• Take a breather and de-stress after interacting with a harassing patient.
• Report the misconduct and discuss the appropriate course of action for future appointments.
• Remind the patient of the need for mutual respect in the medical setting.
• Attempt to understand the reasons behind their dissatisfaction.

Stalking, In Person or Online²

Patients can now have greater access to their physicians via the internet and social media, which can lead to problematic behaviors such as following their doctor on social media, calling after hours, and leaving negative comments on review sites. In fact, a study in the Open Journal of Medical Psychology found that 1 in 10 physicians have experienced patient stalking, often due to dissatisfaction with care or treatment mismanagement. Psychiatrists are particularly vulnerable to stalking by erotomanic patients.

Here are the interventions recommended by the APA’s Council on Psychiatry and the Law to address patient stalkers:

• Call local law enforcement if there is immediate danger
• Keep a cell phone handy at all times
• Park near the security
• Plan an escape route
• Minimize the online presence
• Ensure that alarms and locks work properly
• Install video cameras at entryways
• Consult security firms or law enforcement for safety strategies
• Document the patient’s stalking behavior
• Inform colleagues, staff, and family members
• Obtain protection orders if necessary

Sexually Harassing^3,5

Patients who engage in sexually harassing behavior often cross the boundaries of the patient-doctor relationship. Their actions can create a hostile work environment and make inappropriate comments. They may also touch or grope themselves or the physician. While the patients may consider their behavior harmless or flattering, it can be insulting and harassing to the physician and should be reported.

Physicians should report sexual harassment and transfer the patient to another doctor’s care after informing them about the incidents. Reporting harassing patients can help keep fellow doctors safe from patient harassment.

Conclusion

Violence towards health workers harms their well-being and job motivation, compromising care quality and risking financial loss. Prevention interventions include managing violent patients/visitors and securing emergency healthcare facilities.

References

1. World Health Organization. Preventing violence against health workers. Available at: https://www.who.int/activities/preventing-violence-against-health-workers
2. Bulut S, Usman AC, Nazir T. Stalking of healthcare professionals by their clients: The prevalence, motivation, and effect. Open Journal of Medical Psychology. 2021.
3. Notaro E, Pascoe V, Shinohara MM, DeNiro K. Sexual harassment from patient to provider. International Journal of Women’s Dermatology. 2020 Jan;6(1):30.
4. Holder-Perkins V, Wise TN, Williams DE. Hypochondriacal concerns: Management through understanding. Primary Care Companion to The Journal of Clinical Psychiatry. 2000 Aug;2(4):117.
5. Protecting Your Team from Patient Sexual Harassment. Available at: https://www.chirohealthusa.com/member-providers/protecting-your-team-from-patient-sexual-harassment/