The alert wasn’t a new take; violence prevention has drawn attention in the past. The U.S. Occupational Safety and Health Administration (OSHA) issued a 47-page report in 2004 titled “Guidelines for Preventing Workplace Violence for Health Care & Social Service Workers,” a playbook still in use today. Both the Joint Commission alert and the OSHA report were often referred to in the wake of the Johns Hopkins shooting, in which two people died, as institutions and doctors answered questions about how well their offices, staff and patients were protected.
Explore This IssueDecember 2010
“This is occurring, and it is a systemic problem,” Dr. Schyve said. “Some organizations may have ignored it, and we’re saying you need to think about it in a systemic way…create a culture of remembering things can go wrong.”
But when it comes to violence prevention, terms like “systemic” and “culture” can often sound a bit amorphous to physicians looking for practical advice. Dr. Bradford said otolaryngologists should think about the issue in more narrow terms, such as installing security systems and drafting safety protocols for different situations.
She noted that while physicians often feel a medical and almost societal obligation to help their patients, otolaryngologists would do well to remember they do not have to put up with violent or otherwise inappropriate behavior. “You can fire a patient,” Dr. Bradford said. “We will do that if somebody is disruptive or abusive.”
The process is rare, she cautioned, and should almost always be handled in concert with legal advice, but the overall point she hopes people take away from the idea is that the physician can and should drive the process of creating a safe environment.
Dr. Schyve agreed that physicians need to push the conversation but says it can be difficult to find the right balance between creating an inviting office atmosphere and maintaining unseen security measures. Because many otolaryngologists work in private clinic settings outside the more regimented structure of hospitals and academic institutions, that balance is often something that must be tailored, he said. “In some settings in which controlled drugs are stored, an entrance that is opened only with a buzzer may be necessary,” Dr. Schyve explained, “whereas, in another setting, an unlocked entrance door may be appropriate.”
He added that the mindset of wanting to help patients is the same perspective that often leads physicians to envision rosier outcomes, both about a patient’s prognosis and the likelihood that a patient may be a violent actor. “We have a tendency to be optimistic,” he said. “That optimism…sometimes means we’re not paying attention to the fact that something could go wrong.”