“the impact for caregivers is catastrophic”

It is not only in the face of viruses that caregivers find themselves on the front line. Throughout the year, hospital staff are regularly confronted with acts of violence and aggression from patients and caregivers. Facts that are well known in the medical community and recurrent in emergency services, although they are the subject of low number of complaints. After a downward trend, the number of attacks on doctors started to rise again in 2021. A phenomenon which obviously did not disappear during the summer of 2022.

Saturday August 27, in Mulhouse (Haut-Rhin), a practitioner of SOS Médecins was threatened with death and was shot with a dummy weapon, loaded with balls, during a consultation with a patient. In solidarity with their colleague, the local branch of the federation has suspended all home visits until Monday morning.

Eight days earlier, at the hospital in Cannes (Alpes-Maritimes), this time, a drunken woman attacked a doctor and a nurse, spitting and punching. On the night of August 15, finally, it was a nurse who was put on the ground and a caregiver struck at the Lapeyronie hospital in Montpellier. Cases far from isolated.

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In response to these attacks in Herault and the Upper Rhinethe Minister of Health, François Braun, reacted on Twitter, condemning “firmly” these acts, as well as “all forms of violence against health professionals, which are unacceptable”.

In these cases, it is once again the expectation linked to the delay in intervention or patient care that motivates the taking action. Karim Tazarourte, president of the French Society of Emergency Medicine (SFMU), returns, in an interview with World, on these aggressions which worry caregivers.

What is this violence the translation of?

There is not, as in other places, a phenomenon of direct attacks aimed at “be caregivers”. Something happens in the violence, something that needs to be characterized. In Lyon, this generated a clinical research hospital project in 2016, in order to quantify violence according to four levels of severity. A scale ranging from verbal or physical incivility (level 1) to violence with a weapon (level 4). This is the classification used by the National Observatory of Violence in Healthcare Environments (ONVS).

From now on, we have a declaration of violence by the staff every three days. In 90% of cases, in the emergency room, this declaration is level 1, exceptionally level 2. We also note that nearly half of the violent behavior comes from families, the other from patients. That nearly half of this violence occurs in the first thirty minutes – at reception or in the corridors – and is caused by accompanying persons, while the other half occurs after two hours of presence – generally in the consultation rooms – and is done by the patients.

We know that waiting is a triggering factor. That this phenomenon reflects an undeniable state of tension in society. Especially since today we come up against a part of the population which has a reduced level of vocabulary and which, in fact, finds it difficult to express its feelings and its expectations. Individuals with a low educational level and a limited understanding of our civic system. They perceive the health system as a dark box whose rules they do not always understand and certain situations are unbearable for them.

What are the consequences of this violence on hospital staff?

The impact for caregivers is catastrophic. Many are distressed following a cumulative effect of level 1 or 2 attacks, the number of which is substantial and under-reported, both in the SAMU and in the emergency room, because the caregivers have integrated them, to a certain extent. The number of acts declared at levels 3 and 4 is not very high, around a hundred per year, but after having received blows, a large number of caregivers also leave their careers with anxiety or in post-traumatic stress disorder.

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Among those experiencing violence, there are also high scores in terms of anxiety and loss of performance. Thus, if you are insulted by a third party when caring for a patient in serious condition, it has been shown in the context of a simulation that you lose two thirds of your cognitive means of performance, lasting thirty minutes. The consequences are serious for patient care.

How to stem this phenomenon?

The procedures for filing a complaint are quite cumbersome. Hospital staff do not always want to move and personalize their complaint, at the risk of suffering the consequences.

How then to protect it upstream to limit the consequences of a verbal or physical aggression? By putting more and more barriers between users and caregivers? This has already resulted in services where there is no longer direct contact between the two. Ensure that caregivers are directly supported by the institution? When a carer expresses suffering following an assault, the institution, through a manager or the director, can lodge a complaint in his place, although each service now does as it wishes. As for protection, there are already security guards. But these questions deserve a real debate.

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Also, we have a real problem with the management of waiting times, partly linked to a lack of knowledge of health systems on the part of users but also to poor communication on our part on estimated waiting times. Individuals find it difficult to schedule their wait and this creates frustration. I assume that we have some of the violence that could be avoided if we managed to plan the routes better. This requires better information that mobile applications or other tools made available to us could provide.

Finally, we have agitated patients, often out of treatment. That’s another matter, although they pose a major danger to themselves and others.

This aggressiveness is therefore not free, it is mainly due to users who do not understand how the system works and enter into postures of total frustration in the face of constraints, as well as a more agitated patient profile and for whom our services must re-equip with specific circuits. The hospital which was once a place of sanctuary – a place where no one clashed – is becoming a place like any other. There is no fatality, but a lot of work upstream.


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