The Hidden Dangers of a Medical Career

On October 4, staff, patients, and medical students at my institution received word that a fatal shooting had occurred inside the campus hospital. For staff, this was a painful event compounding the already stressful pandemic times, while for students, it was a harsh introduction to the emerging dangers of practicing medicine.

Sure, medicine is widely known to be a grueling profession that requires sacrifice, but few realize the dangers to their own safety that providers routinely face. Unfortunately, acts of violence targeting healthcare workers occur at surprisingly high rates.

Reports following the shooting indicated that the gunman had a personal conflict with a coworker, and thankfully, larger numbers of people had not been targeted. While this may seem like a one-off incident, any shooting inside a hospital is a serious matter. Hospitals should be places of healing. Yes, they are inevitably places of suffering as well, but this pain should never be human-inflicted.

Healthcare workers are widely admired in the community, and increasingly so due to their sacrifices during the COVID-19 pandemic. Even though there is more attention to our healthcare spaces, the epidemic of occupational violence against our country's healthcare workers has gone largely unrecognized, and this danger has only worsened since the onset of the pandemic.

Acts of violence against healthcare workers not only include fatal shootings or stabbings but may also include physical or verbal aggressions by frustrated patients and visitors. It is likely that students entering the healthcare field will encounter such danger during their careers.

Healthcare workers have four times the likelihood of being assaulted on the job compared with those working in private industry. The World Health Organization reports that 38% of health workers can expect to experience physical violence at some point in their careers, while verbal threatening was reportedly even more common. It is plausible that the true rate of violence surpasses these rates, as reporting is entirely voluntary.

In fact, the American Journal of Managed Care reported in 2019 that 75% of workplace assaults occur in healthcare, yet only 30% of nurses and 26% of emergency department physicians report such experiences.

Anecdotally, many of my own physician mentors have shared stories of troubling or threatening situations they have faced throughout their careers. These types of situations can be difficult to avoid, as providers are trained and naturally inclined to empathize with their patients and help as much as possible, making it difficult to turn away potentially violent individuals.

Since the start of the COVID-19 pandemic, as the public became more fatigued, incidents of violence rose. Facing staffing shortages, visitor restrictions, and high-acuity patients, healthcare workers found it increasingly difficult to manage large caseloads. Becoming highly stressed were not only patients, who were facing some of the toughest times of their lives, but also staff, who experienced rising demands.

Meanwhile, gun violence in our country has profoundly increased during the pandemic, creating an unstable backdrop to this tension.

Obviously, acts of violence against healthcare workers are unacceptable. Such events can pose real physical harms to providers, possibly resulting in irreversible injury, health problems, or even death. Additionally, they can yield long-term psychological harms, increase burnout, and impact job satisfaction.

Healthcare providers already make huge personal sacrifices to pursue their profession, and this threat of violence is an additional burden they unfortunately face.

In addition to the direct harm to employees, violence also has broader systemic detriments to patient outcomes and healthcare economics. Acts of violence against healthcare workers can lower the quality of care provided to patients — either directly, by virtue of being present during such dangerous situations, or indirectly, as stressed or burned-out providers may understandably be unable to provide optimal care. Rates of avoidable errors naturally rise in the presence of such stressors.

Unfortunately, regulations protecting healthcare workers from violence are sparse, and hospitals are not currently required to implement prevention plans for workplace violence. There are certainly some common-sense changes that institutions have begun implementing, including the use of metal detectors upon entry or the increased presence of security staff, but generally, it is questionable whether these measures alone can fully eliminate violence.

The first step in addressing this unacceptably common issue is to boost awareness and brainstorm creative solutions. Healthcare workers and medical students should at least be made aware of this widely prevalent threat, and safety training can be implemented to parallel that of our nation's other schools, which have unfortunately faced a similar plight for decades.

However, similar to most issues in medicine, prevention is certainly the best strategy. By highlighting the unbelievably prevalent nature of this issue, along with its severe human and financial costs, hopefully we can draw the attention of policymakers to catalyze lasting change with a preventative focus.

The Thomas Jefferson University community responded to this tragic event with a message of resilience, offering mental health services, increasing its law enforcement presence, and promising to revisit physical security measures. This all-too-familiar pattern has been seen with previous acts of violence, but it has not yet yielded a true solution. Yet there's not too much more an individual hospital can do without broader systemic change.

We must improve our awareness and understanding of the deep-rooted factors underlying this public health crisis and adapt how we communicate about them to achieve real progress.

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About Yash B. Shah

Yash Shah is a first-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pennsylvania. He earned a bachelor of science in premedicine from Penn State University. Prior to attending medical school, Yash worked on clinical and translational research in hematology/oncology at the Children's Hospital of Philadelphia. Yash has long-standing interests in advancing medical education, improving healthcare policy and economics, and working with cancer patients. In his free time, he enjoys playing tennis, rooting for the Eagles, reading, and traveling.

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