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By Larry B. Mellick, MS, MD, FAAP, FACEP
Chair and Professor, Department of Emergency Medicine
Section Chief, Pediatric Emergency Medicine
Medical College of Georgia, Augusta
(Editor’s note: All names have been changed for this article.)
"You aren’t going to believe what happened last night," said Rebecca Roberts, a new emergency medicine attending. "I was inquiring about the procedure for cervical spine X-rays, and the radiology attending, Dr. Christopher, became very irate."
Rebecca, who was nine months pregnant, described how Dr. Christopher had put his hand on her shoulder, pushed her against the view boxes, and cursed at her with his face six inches from hers. Even though her inquiry had been innocent, tension already had been developing between radiology and emergency medicine over the management of patients with trauma-related neck pain.
The medical director, Dr. Renae, was concerned about a number of issues. The behavior of Dr. Christopher seemed even more incomprehensible when Dr. Roberts’ pregnancy was considered. There also was concern that this might be the bellwether of an emotional health issue or personal life stress.
Furthermore, she recognized that Dr. Christopher’s actions were legally consistent with assault and battery. Besides failing to show proper etiquette to the new emergency attending, the older radiologist was potentially in deeper trouble because of his actions. In that the event was just one of several recent verbal attacks and displays of aggression against emergency medicine staff, Dr. Renae recognized that a strong response was indicated.
First, the chairman of radiology was contacted by telephone and requested that a meeting be scheduled immediately between the two doctors as well as the chairs of the two departments. Within 24 hours of the event, Dr. Roberts decided to make a police report of the incident. Dr. Renae supported this decision. While she wanted to preserve the overall good relationship between the two departments, an investigation of the event by the police seemed to match the seriousness of the offense.
Subsequently, Dr. Roberts decided not to press charges against Dr. Christopher. During the meeting, the radiology attending offered his apology personally and in a formal letter to Dr. Roberts. Dr. Roberts was satisfied with the outcome of the meeting, and no further problems with Dr. Christopher were experienced during the next several years. On the other hand, how radiology technicians managed neck pain was a little more difficult and slower problem to resolve.
One month before this incident, one of the surgical fellows, Laurence Davis, had arrived in the ED in a foul mood. He was upset that the ED attending had placed a chest tube before his arrival. Dr. Davis began by picking up and slamming down books on a counter and then throwing papers and objects onto the floor. The ED staff was convinced that someone was going to be hurt, and one staff member started to call the police. Fortunately for Dr. Davis, things to throw had become scarce before the telephone call could be made.
The chairs of emergency medicine and surgery met with Dr. Davis, who formally apologized for losing control. (Although a promised formal apology to the ED attending is still pending years later, Dr. Davis has displayed no additional outbursts of uncontrolled anger.)
The following week, the chair and medical director of the ED met to discuss the implications of these events. It was clear that various colleagues were subjecting ED staff to a pattern of abuse, and departmental morale was being impacted adversely. A strategy was needed to interrupt this pattern.
According to the hospital lawyer, most of the events that occurred against the ED staff were consistent with the legal definition of battery. In each case, individual staff members had reported that they felt threatened physically by the angry outburst. The chief of security agreed that his staff would respond promptly if called during any future events. A policy was established that a police investigation would be expected following any future events.
The ED chairman sent a letter to the chief of staff at the hospital detailing each of the recent events. He was subsequently invited to present his concerns at a medical staff executive meeting, where a resolution was passed for a "zero tolerance" policy for any verbal or physical assaults toward ED or other hospital staff members.
Finally, a training format was established to allow the ED staff to more effectively manage rage behaviors. As soon as an outburst event was noted, as many as five staff members would quietly appear to flank the person from the front and both sides. One staff member taking a lead communication role would quietly ask the offending individual to lower his or her voice and to bring the behaviors under control. This formation was intended to protect the unfortunate individual receiving the verbal assault, as well as deliver the strong message that comes from being surrounded and outnumbered.
While no one knows for sure, there seems to have been a direct association between the strong measures taken and the fact that no further assault episodes against ED staff members have occurred in the subsequent four years.
[Editor’s note: Contact Mellick at Medical College of Georgia, Department of Emergency Medicine, 1120 15th St., AF 2036, Augusta, GA 30912-2800. Telephone: (706) 721-7144. Fax: (706) 721-7718. E-mail: LMELLICK@mail.mcg.edu.]