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| A doctor inspects a patient at the ER unit at one of Beirut’s hospitals, where work does not always run so smoothly. - Mahmoud Kheir - 7 -18 - 2011 |
BEIRUT: One nurse had a gun pointed at her. Another was assaulted by a patient and his relatives who complained of waiting for treatment.
Emergency rooms are supposed to be places where the injured are treated and lives are saved, but ERs across the country are too often battlegrounds between patients, their relatives and hospital staff. Facing insults and physical violence, health professionals are calling for greater awareness of the issue, and more protection.
The issue was underscored in a study on greater Beirut hospitals conducted in 2009 by a team of researchers from the American University of Beirut. The study showed that one out of four ER workers had been physically assaulted, and four out of five had been verbally assaulted.
Professor Mohammad Alameddine, the study’s main researcher, believes incidents do receive more attention since the release of the report, but said that “not much has been done.”
Of the five nurses contacted by The Daily Star, two had been physically attacked. The nurse who was assaulted by the patient and his relatives lost his hearing after being punched in the ear, and filed suit against the patient.
At Hotel Dieu hospital, ER director Antoine Zoghbi says that physical attacks are a rare incidence but verbal violence is a serious, and daily, problem.
“It [physical attacks] might happen once a year, when we receive an average of 3,500 patients per month,” he said. “Some small shouting, some louder shouting, insults … this happens every day.”
These frequent confrontations have a severe impact on his staff, he said.
“The staff gets burned-out but [still manage to] take it,” he said, lamenting that “at some point they feel it’s part of their work.”
“The ER is a place of high tension; people are worried and feel helpless. Because of the stress, any incident can lead to a serious and open conflict,” he said, adding that he sometimes feels there is a “battle between two armies” – the staff and the patients’ relatives – in the ER.
At Haykal hospital in Tripoli, director Richie Haykal says he has seen many incidents, and also believes they affect his staff, who are “depressed” at times and refuse to work in the ER.
He says that incidents take place every 10 days on average and, in most cases, involve inebriated people.
Recently, a group of men arrived at the hospital armed with knives, breaking doors and windows and demanding that the doctors treat an injured friend.
“He was already dead when they arrived,” said Haikal.
Sleiman Haroun, head of the Union of Private Hospitals, said that last year an agreement was made with the police who now consider security at hospitals a “top priority” and intervene more.
“The problem hasn’t been completely solved,” said Haroun, who sees violence in the ER as a “derivative” of other problems.
He believes politicians’ attitude toward hospitals is a “key factor,” lamenting what he called a “perpetual campaign against hospitals” by politicians who he says keep repeating that hospitals “treat their patients badly.”
“This creates an unhealthy atmosphere in hospitals and [generates] public animosity toward hospitals,” he said.
Amin Kazzi, president of the Lebanese Society for Emergency Medicine who also participated in the 2009 AUB study, believes that having “aggressive or violent patients and patients’ [relatives], is unacceptable.”
“There should be zero tolerance for such expressions of discontent or distress,” he said.
But he admits there is a real need to improve the conditions in hospitals, acknowledging there is as a clear lack of adequate resources.
“Delays or restrictions standing between patients’ needs and available resources causes friction,” he said, adding this could “escalate and is escalating on a daily basis into aggression and verbal abuse, and infrequently into physical violence.”
One nurse, who like all nurses interviewed requested her name and workplace be withheld, has worked for 30 years and agrees that physical incidents are rare, but verbal abuse is not.
“During the war we were constantly assaulted; people were shooting on the [hospital] floor,” she said.
Today, she says the situation in the country is different but nurses continue to be verbally assaulted “in a strong and unbearable way” on a daily basis.
“People don’t want to wait, they get impatient … We get insulted; they don’t touch us but raise their hands and threaten,” she said.
Another nurse says the situation is worse at night.
“We get people who have been drinking a lot and their aggression is uncontrollable,” he said.
Sharaf Abu Sharaf, head of the Physicians’ Union, believes the current situation is “not normal” and calls on the ministries of health, interior and justice to take action.
“The ER needs to be well-equipped to receive patients, have security measures in case of incident … and offenders need to be arrested,” he said.
“Two weeks ago a doctor was attacked by a patient at the Bekaa hospital who wasn’t arrested as usual.”
“This is a serious problem,” he said, warning that if no solution is found, “we won’t have anyone working in the ER.”
At Bsharri public hospital, the government’s delegate Emile Tawk also says that violence is very rare.
Last month though, the media reported on an incident during which a doctor was attacked by a patient’s relative, which led to a three-day strike by the staff.
Tawk said the incident was misreported and described it as a “misunderstanding.” He explained that the father of a young patient, whose son died in the same hospital a few years earlier because of a bad reaction to anesthesia, “panicked” when he heard his second son also had to have anesthesia.
“The doctor didn’t know the story. There was a small scramble, and unfortunately the doctor got punched in the stomach,” Tawk said, adding it might not have been on purpose.
The workers’ strike was a result of the “general atmosphere” more than of the incident, he said.
“The atmosphere is quite tense. Because of the hospital’s finances, workers are afraid to lose their job,” he said. “Everyone is exhausted.”
Alameddine says that stakeholders from public and private hospitals were working recently on a policy report to improve the situation.
The report, which should be released before the end of the month, makes recommendations like implementing an effective anti-violence policy and staff trainings so workers can identify violent patients or relatives and learn how to communicate with people in distress.
The recommendations will include confidential reporting of violent incidents, and calls for enhancing the security apparatus and the role of the police.
Alameddine believes patients would benefit from a safer environment too, as workers would be able to concentrate better and be more dedicated to their work than in a “toxic environment.”
Emergency rooms are supposed to be places where the injured are treated and lives are saved, but ERs across the country are too often battlegrounds between patients, their relatives and hospital staff. Facing insults and physical violence, health professionals are calling for greater awareness of the issue, and more protection.
The issue was underscored in a study on greater Beirut hospitals conducted in 2009 by a team of researchers from the American University of Beirut. The study showed that one out of four ER workers had been physically assaulted, and four out of five had been verbally assaulted.
Professor Mohammad Alameddine, the study’s main researcher, believes incidents do receive more attention since the release of the report, but said that “not much has been done.”
Of the five nurses contacted by The Daily Star, two had been physically attacked. The nurse who was assaulted by the patient and his relatives lost his hearing after being punched in the ear, and filed suit against the patient.
At Hotel Dieu hospital, ER director Antoine Zoghbi says that physical attacks are a rare incidence but verbal violence is a serious, and daily, problem.
“It [physical attacks] might happen once a year, when we receive an average of 3,500 patients per month,” he said. “Some small shouting, some louder shouting, insults … this happens every day.”
These frequent confrontations have a severe impact on his staff, he said.
“The staff gets burned-out but [still manage to] take it,” he said, lamenting that “at some point they feel it’s part of their work.”
“The ER is a place of high tension; people are worried and feel helpless. Because of the stress, any incident can lead to a serious and open conflict,” he said, adding that he sometimes feels there is a “battle between two armies” – the staff and the patients’ relatives – in the ER.
At Haykal hospital in Tripoli, director Richie Haykal says he has seen many incidents, and also believes they affect his staff, who are “depressed” at times and refuse to work in the ER.
He says that incidents take place every 10 days on average and, in most cases, involve inebriated people.
Recently, a group of men arrived at the hospital armed with knives, breaking doors and windows and demanding that the doctors treat an injured friend.
“He was already dead when they arrived,” said Haikal.
Sleiman Haroun, head of the Union of Private Hospitals, said that last year an agreement was made with the police who now consider security at hospitals a “top priority” and intervene more.
“The problem hasn’t been completely solved,” said Haroun, who sees violence in the ER as a “derivative” of other problems.
He believes politicians’ attitude toward hospitals is a “key factor,” lamenting what he called a “perpetual campaign against hospitals” by politicians who he says keep repeating that hospitals “treat their patients badly.”
“This creates an unhealthy atmosphere in hospitals and [generates] public animosity toward hospitals,” he said.
Amin Kazzi, president of the Lebanese Society for Emergency Medicine who also participated in the 2009 AUB study, believes that having “aggressive or violent patients and patients’ [relatives], is unacceptable.”
“There should be zero tolerance for such expressions of discontent or distress,” he said.
But he admits there is a real need to improve the conditions in hospitals, acknowledging there is as a clear lack of adequate resources.
“Delays or restrictions standing between patients’ needs and available resources causes friction,” he said, adding this could “escalate and is escalating on a daily basis into aggression and verbal abuse, and infrequently into physical violence.”
One nurse, who like all nurses interviewed requested her name and workplace be withheld, has worked for 30 years and agrees that physical incidents are rare, but verbal abuse is not.
“During the war we were constantly assaulted; people were shooting on the [hospital] floor,” she said.
Today, she says the situation in the country is different but nurses continue to be verbally assaulted “in a strong and unbearable way” on a daily basis.
“People don’t want to wait, they get impatient … We get insulted; they don’t touch us but raise their hands and threaten,” she said.
Another nurse says the situation is worse at night.
“We get people who have been drinking a lot and their aggression is uncontrollable,” he said.
Sharaf Abu Sharaf, head of the Physicians’ Union, believes the current situation is “not normal” and calls on the ministries of health, interior and justice to take action.
“The ER needs to be well-equipped to receive patients, have security measures in case of incident … and offenders need to be arrested,” he said.
“Two weeks ago a doctor was attacked by a patient at the Bekaa hospital who wasn’t arrested as usual.”
“This is a serious problem,” he said, warning that if no solution is found, “we won’t have anyone working in the ER.”
At Bsharri public hospital, the government’s delegate Emile Tawk also says that violence is very rare.
Last month though, the media reported on an incident during which a doctor was attacked by a patient’s relative, which led to a three-day strike by the staff.
Tawk said the incident was misreported and described it as a “misunderstanding.” He explained that the father of a young patient, whose son died in the same hospital a few years earlier because of a bad reaction to anesthesia, “panicked” when he heard his second son also had to have anesthesia.
“The doctor didn’t know the story. There was a small scramble, and unfortunately the doctor got punched in the stomach,” Tawk said, adding it might not have been on purpose.
The workers’ strike was a result of the “general atmosphere” more than of the incident, he said.
“The atmosphere is quite tense. Because of the hospital’s finances, workers are afraid to lose their job,” he said. “Everyone is exhausted.”
Alameddine says that stakeholders from public and private hospitals were working recently on a policy report to improve the situation.
The report, which should be released before the end of the month, makes recommendations like implementing an effective anti-violence policy and staff trainings so workers can identify violent patients or relatives and learn how to communicate with people in distress.
The recommendations will include confidential reporting of violent incidents, and calls for enhancing the security apparatus and the role of the police.
Alameddine believes patients would benefit from a safer environment too, as workers would be able to concentrate better and be more dedicated to their work than in a “toxic environment.”
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