Although assault and injury are risks to doctors on call, few take precautions.
The use of training, chaperones, panic buttons, electronic notifications, tracking devices, and vetting patients that may pose a higher risk of initiating aggression and violence, serve to reduce the danger to the doctor, but the costs associated with all but the last of these measures often hinder their introduction.
The following provides practical guidance for doctors attending home visits concerning their personal safety that are relatively straight forward and cost effective to implement.
Safety policy for doctors are developed by practice managers, and at their best, in cooperation with staff members. Most attention concerning safety is focused on issues that may occur in the practice itself rather than when the doctor is on a home visit, but doctors are most at risk of personal injury when on call. A short outline follows that can form the basis for developing a policy that specifically addresses personal safety.
Policy Aims: set out the central purpose of the policy in clear and simple language, and judge the policy in the whole as always serving these aims. For example, this policy aims to reduce risks to personal safety that doctors face both in their practice and on home calls.
Actionable Targets: describe in detail the measures that must be in place that support the policy, for example regular training in de-escalating conflict rather than one-off sessions, instillation of panic buttons, and automated phone notifications for home visits etc.
Implementation: make clear who is responsible for originating the policy, monitoring it’s effectiveness and the frequency of the review process, and whether changes need to be made to the overall policy in light of its performance.
One of the most effective measures to counter potential threats to personal safety when on a home visit is to be prepared. The most straightforward action by the doctor is to call the patient before the visit to better establish what the problem is, and through this conversation gauge the patient’s attitude and composure. The call can also discuss the patient’s environment with particular attention given as to whether there are any pets. The doctor can then request the pet is not be present in the treatment room at the house as the doctor will need the room to be as clean and free from potential sources of bacteria as possible.
Time devoted to high quality training is another effective way the doctor can be prepared for the different kinds of risks they may come across on a home visit. The resistance to investing in training is twofold: perceived low risk, and cost. It may be that few if any direct and serious personal threats have taken place in a given practice, and the mindset of the practice may be similar to an individual’s resistance to paying for insurance cover. When an event that threatens personal safety does occur, those who have received training will always fair better.
Take one narrative that serves to make the point.
A doctor is sent to visit an elderly patient in their eighties who has fallen. Their job is to assess whether the patient requires further medical investigation, or whether pain relief and rest will be sufficient. On the face of it this home visit presents little risk, however when the doctor enters the house he is met by the bark of an aggressive dog coming from the next room. With appropriate training the doctor would call on the strategies he learned to better ensure his personal safety. Without training, the doctor needs to think on the spot about their risk, and inevitably, they will not focus as well on the care they give to their patient.
Good preparation in the form of training for various scenarios, from problems with pets to dealing with aggressive and abusive patients, will not only help doctors operate from a less stressful baseline and serve to protect their safety, it will increase the care provision and quality of practice patients.
People who work alone, at night, or in high crime areas are subject to greater personal risk in the form of acts of abuse and violence. On occasion, one, two, or all three of these criteria will be experienced by doctors during their work.
Doctors need to recognize potential conflicts that may begin simply as a sudden change of body language, eye contact, or disruptive behaviour like a patient raising their voice, or offering resistance to complying with social norms.
The following checklist presents a base level skill set, however this is not exhaustive and should only be the start of a doctor’s learning and training of de-escalation techniques:
Note that most assaults occur when restraints or sedation is attempted. De-escalation is far less costly and time consuming.
Medical practices should provide resources and training in conflict de-escalation to doctors as a matter of routine. Those doctors who do not enjoy support of this kind are strongly recommended to review the resources available for them in their country’s medical association web site and documentation.
People who work alone, at night, or in high crime areas are subject to greater personal risk in the form of acts of abuse and violence.
On occasion, one, two, or all three of these criteria will be experienced by doctors during their work.