The Root Causes of Violence in Hospitals: A Surgeon’s Perspective

Often, we make excuses for the violence that occurs in hospitals. We blame the entertainment industry, the inefficiencies in the healthcare system, the government, alcohol, and drug addiction, as if they are the sole reasons. In reality, people tend to resort to violence as a result of their own choices, and every excuse we give only masks the true issue.

Personal Experience: Observations from Spain

During my training as a surgeon in Spain, I seldom observed instances of violence. The few incidents that did occur were primarily from patients who believed they had waited too long or had been wronged. A couple of cases involved intoxicated individuals. It's clear that the primary issue stems from a combination of factors, including inefficiency and abuse of the healthcare system.

In countries with universal healthcare access, people often believe they have a right to any medical attention they need, regardless of its severity. They tend to go to the emergency department for minor issues rather than waiting for a general appointment. Examples include tiny splinters, earlobe piercings, and nosebleeds. Because hospitals are reimbursed based on the number of patients treated, both emergencies and non-emergencies, the system becomes unbalanced, leading to longer wait times for everyone.

The Complexity of Violence in the Emergency Department

Every week, I or my colleagues face threats of violence. But my experience is primarily focused on the Emergency Department, where the main causes of violence can be broadly categorized into three groups: impatience, alcohol, and mental illness.

Impatience and Perceived Severity: A Common Catalyst

The most significant reason for violence in the Emergency Department is impatience. Patients often feel that their condition is much more serious than those of others. When told they must wait, they feel aggrieved. I have lost count of the number of times I have heard, 'Do you know who I am?' As a surgeon, I have encountered numerous situations where a patient’s sense of urgency spirals out of control, leading to abuse and threats.

The Role of Alcohol: A Driving Force for Violence

In the United Kingdom, Stella Artois is colloquially referred to as the 'wife beater,' and individuals intoxicated with alcohol are particularly prone to violence. These individuals are often happy to challenge any and all comers, including hospital staff. They can be rude, unpleasant, and very scary. Alcohol can cloud judgment and exacerbate pre-existing behaviors, increasing the likelihood of violent outbursts in a medical setting.

Mental Illness: Misunderstood and Threatened

Mental illness can also lead to violence, as seen in the case of a patient who tried to strangle me. Patients with mental health issues may not understand the intent and efforts of healthcare providers. Instead, they see the staff as a threat and may react violently. This further complicates the situation for medical professionals.

The Predominance of Aggression in Society

In any society, there are individuals who get what they want through aggressive and violent behavior. These individuals do not change their approach when they enter a hospital. They use threats and intimidation to manipulate the system and achieve their desired outcomes. These behaviors are particularly prevalent in the Emergency Department, where every minute counts.

It is essential to recognize that while external factors such as alcohol and mental health issues contribute to violence in hospitals, the primary driver is often the behavior and mindset of the individuals involved. Addressing these underlying issues requires a multifaceted approach, including improved communication, patient education, and enhanced security measures in healthcare settings.

Keywords: hospital violence, emergency department, causes of violence