Over half of the doctors who responded to a Medical Protection Society (MPS) survey (58%) say they have experienced or witnessed verbal abuse, physical violence or damage to their work premises from patients or their relatives in the past 12 months, with a quarter (24%) saying such abuse is impacting their mental wellbeing.
In the MPS survey of more than 660 healthcare practitioners, a third (34%) said they have seen more abuse recently, than during the COVID-19 pandemic.
Nearly two-thirds (65%) said incidents of abuse were not taken seriously by the authorities, while 80% of respondents who were considering leaving the healthcare profession cited an increase in abuse as an influence for their decision.
The release of the survey results come in the tragic aftermath of the murder of Dr Michael Isabelle, who was killed at his Dobsonville practice in Soweto late last month.
Healthcare practitioners who took part in the survey commented anonymously about their experiences of being threatened and abused at work.
One healthcare practitioner said: “I have regularly witnessed patients abusing doctors and saying that doctors have taken an oath to serve and should therefore accept abuse.”
Another said: “I have been verbally abused and threatened by my last patient today because of the unavailability of the medication I prescribed.”
Another added: “Due to fatigue and everyday stressors, no one has the energy to report issues to HR or management instead you find yourself too depressed to work in that environment.”
MPS, which protects the professional interests of over 30,000 healthcare practitioners in South Africa, said the survey results show the worrying impacts of violence at work.
Dr Volker Hitzeroth, Medicolegal Consultant at MPS, said: “These survey results make for sombre reading and demonstrate how abuse and violence at work can severely impact healthcare practitioners’ mental wellbeing. This is on top of a range of other pressures which make for an extremely challenging environment - including staff, medicine and equipment shortages as well as load-shedding.
“What is perhaps worse is the notion that abuse is now just ‘part of the job’, with healthcare practitioners accepting that there is no accountability for the perpetrators of abuse, and little support available to help them tackle the effects of it on their mental wellbeing.
“Experiencing and witnessing incidents of physical, sexual or verbal abuse can have a lasting and profound impact on mental wellbeing and this can be damaging for the individual as well as for patient care. It can also result in healthcare practitioners needing to take time off work, and even quitting medicine altogether.
Dr Hitzeroth said the survey results highlighted the need for more to be done to tackle patient abuse and improve support for doctors who experience such behaviour.
“We need to see more local mental wellbeing resources established so those healthcare practitioners struggling due to abuse and violence at work, and other wellbeing issues, can access appropriate support.
“It is also clear that we need a greater security presence at all healthcare facilities, clear signage telling patients that abuse is not acceptable, and warnings to patients when they see a doctor that abuse will not be tolerated. Management of both private and public facilities also need to start taking a firm and consistent line when dealing with patient abuse so that when something happens there is a swift and clear response to ensure the behaviour is never repeated.
“In addition, MPS will share these survey results with the HPCSA and raise the possibility of the regulator strengthening its National Patients’ Rights Charter (as set out in Guidelines for Good Practice in the Health Care Professions), by introducing clearer responsibilities for patients and their accompanying family members to refrain from any form of abuse, threats, or violence and detail what steps may be taken in the event such acts occur."
Dr Hitzeroth continued: “In our survey, 80% of respondents who are considering leaving the healthcare profession cite increasing abuse from patients or their families as an influence for their decision, while 68% who are looking to leave South Africa to work elsewhere cite abuse as an influence.
“If we don’t do more to tackle this issue, sadly we may lose many more healthcare workers at a time when the profession can least afford it.”
Doctors who participated in the MPS survey commented anonymously:
“Patients become abusive when they do not want to pay for medical services rendered to them.”
“Sadly there isn’t a forum to discuss these issues and there is no avenue for accountability.”
“After COVID-19 people are under enormous pressure, emotionally and financially. They tend to lash out because of that.”
“I have been verbally abused and threatened by my last patient today because of the unavailability of the medication I prescribed.”
“Due to fatigue and everyday stressors, no one has the energy to report issues to HR or management instead you find yourself too depressed to work in that environment.”
“Families and patients expect to be seen immediately for routine treatment and refuse to accept that other patients might have more urgent needs. Doctors are expected to be super-human.”
“I have regularly witnessed patients abusing doctors and saying that ‘doctors have taken an oath to serve’ and should therefore accept abuse.”
“Abuse from patients and families are common. But they are abusive because they are scared and frustrated. It is understandable. The way to handle it is by building a rapport and trust. The problem lies in numbers. If I have a bit of time with patients and family, that can be done easily. When I have 20 patients waiting, no stock and zero morale in unit it is hard to do.”
“In my experience there is zero attempt on the part of the authorities or the hospital groups to protect healthcare workers from abuse by patients and/or their relatives.”
“Patients and families are aggressive and confrontational. I sometimes feel threatened.”
ENDS
Notes
- For further information contact [email protected]
- Medical Protection offers an independent counselling service to members in South Africa experiencing work-related stress, or stress that they feel could impact their practice. This is a benefit of membership. More information is available at https://www.medicalprotection.org/southafrica/help-advice/counselling-service
- The MPS survey was completed by 662 medical professionals in South Africa. The survey was in the field in October 2023.
Key findings
- 44% of doctors in South Africa say they have experienced or witnessed verbal or physical abuse from patients or their relatives in the past 12 months.
- 5% say they have experienced or witnessed physical abuse from patients or their relatives in the past 12 months.
- 9% say they have had property or healthcare premises damaged by patients or their relatives.
- 34% say they have seen more abusive behaviour from their patients and their families recently, than during the COVID-19 pandemic.
- 80% of respondents who are considering leaving the healthcare profession cite increasing abuse from patients or their families as an influence for their decision.
- 68% of respondents who are considering leaving South Africa to work elsewhere cite increasing abuse from patients or their families as an influence for their decision.
- 24% said verbal or physical abuse from patients or their relatives has impacted their mental wellbeing.
- 65% said incidents of abuse from patients or their relatives were not taken seriously by the authorities and the Health Professions Council of South Africa.
About MPS
The Medical Protection Society Limited (“MPS”) is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.
Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.
Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.
MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.