In their daily work doctors routinely find themselves in a confined space with someone in need. In general this presents no risk, however on occasion a patient may arrive or become increasingly agitated and aggressive. Despite the best efforts of the doctor to calm the situation, the patient’s actions may continue to escalate until a point when the doctor’s safety is in jeopardy, and an alarm needs to be raised for assistance.
Review various improvements that can be made to the medical practice environment that are designed to protect a doctor’s personal safety.
Additional positive outcomes of implementing changes that increase personal safety can include greater practice efficiency, staff retention, and higher staff and clinician satisfaction.
There are two uses of an alarm. The first is as an alert that provides colleagues notification of a problem, but gives no sign the alarm has been activated from the patient’s point of view. This allows support to arrive for the doctor before the problem escalates.
The second kind of alarm is very loud and designed to act as a strong deterrent to the aggressor so that they immediate cease. Not only is this kind of alarm physically distressing, it also serves to alert staff members to rush to the doctor’s assistance.
Panic buttons fitted to the doctor’s desk or integrated into the practice computer system can be valuable in alerting others to a problem the doctor is experiencing. It is important however that thought is given to each particular alarm as to whether it serves the first or second function described above. There may for example be a dedicated hot key on the doctor’s desk or computer keyboard that has been integrated into the practice network that raises a ‘quiet alarm’ for assistance (note that such a key or button should not be obvious to the patient), and a second hot key or button that triggers a general emergency alarm for any member of staff to rush in and help.
It may be that only a single alarm is integrated because of circumstances or costs. Discussion in the practice should take place about what kind of alarm is best suited to the needs of the doctors given the kinds of patient that are treated. If for example there is a high number of drug dependent patients that attend a practice, and that incidents of aggression are common place, a general alarm rather than a quiet notification is likely to be the more appropriate choice.
In the case of any alarm in the medical practice, ideally there needs to be a visual cue in the form of a flashing light outside the doctor’s office that indicates the exact location of the room where the alarm was initiated. Aggression is not always accompanied by shouting or loud sounds, and the light will ensure help arrives more quickly.
A personal key-chain alarm positioned in an accessible area on the desk or in a pocket can also be an effective way to deter an attack and alert others of an emergency.
Doctors in the main make house visits on their own. This generally presents no threat to personal safety, however there are a number of considerations that may increase their risk, including the location, type of home, and whether the patient is known as having been aggressive or abusive to the practice in the past.
The most effective means to safeguard doctors as they visit patients at home is to be accompanied by another member of staff. The relative infrequency of problems arising as a result of home visits, together with the costs of paying for an additional member of staff to attend, often prevents this from being an option. If however a patient is known to be aggressive or violent, and a home visit is required, it is a duty of care of the medical practice that the doctor is accompanied.
A dedicated single button emergency alarm that immediately sends a notification to the doctor’s assistant or practice is the easiest to use when making home visits. These systems can however be costly, but in certain practices where the doctor frequently attends high risk areas, they offer a simple and effective means to call for help.
Mobile phones are perhaps the most flexible, cost effective, and convenient alarm systems for the doctor, but they will need setting up so they work well. There is often no time for a doctor to enter a number or phone when a patient suddenly becomes aggressive, so it is important the phone is configured appropriately.
Dedicated emergency mobile phones should be set up and used by doctors attending home visits. Personal phones should never be used when on call as they present their own risks. If for example a personal phone is left or taken from the doctor when on call, the phone’s contact details and other personally identifiable information may be vulnerable.
The dedicated emergency smart phone provided by the practice for doctors should be configured with an app to allow for a single button press to send an alarm with a preconfigured text message together with the location of the phone that immediately notifies the medical practice that a problem has arisen and where.
The phone can also be used to act as a break on someone who is being verbally aggressive as they become aware someone else is listening. An aggressor who remains in control may consider the conversation could also be used as evidence of their aggression and this may serve to calm the exchange. It is however important that the patient does not view the phone in any way as a threat, or method to control, as this is likely to exacerbate the situation.
Calling the practice openly on a phone with a direct appeal for assistance in the presence of a patient who is aggressive, may result in greater personal vulnerability.
Phones can also be used conventionally to notify the practice of a problem. When used it is important the practice has ensured all staff are aware of a special phrase that on the face of it appears innocuous but in truth serves to raise the alarm. For example, “Hello, this is the doctor on call, can I speak with Jack about my next patient? I think I may be delayed”. The practice should note the call comes from the doctor’s emergency phone and that assistance is required.
Alarms and notifications are invaluable in serving to protect doctor’s at work. Although some systems are costly, others like those associated with a smart phone are affordable and easy to implement at any practice. There is nothing so important as personal safety, and it only need take a little time and effort to ensure doctors are better supported in their work during those relatively rare occasions when they are at risk.
There are two uses of an alarm.
The first is as as an alert that provides colleagues notification of a problem, but gives no sign the alarm has been activated from the patient’s point of view.
The second is loud and designed to act as a strong deterrent to the aggressor to immediately cease.