The BBC reports today that Assembly Members in Wales are concerned about the lack of progress made in dealing with violence and aggression towards health care workers. I’m concerned too. In fact I despair. Over 50000 health care workers are victims off assault every year, 3500 of them are GPs, nurses and other staff in primary care. In 2007 trainee GP Johannah Langmead was assaulted by a mentally ill patient in her surgery in an unprovoked attack that kept her off work for nearly two months with anxiety and flashbacks. Her attacked was spared jail due to his mental illness.
When I was assaulted I was an SHO in psychiatry, and had been called to the “136 suite”. Section 136 of the Mental Health Act allows policemen to apprehend someone who appears to be suffering from a mental disorder and take them to a “place of safety”, usually the acute psychiatric unit. I had at this point been in psychiatry for about four months so I had done this before many times. I entered the room to assess the woman who had been brought in, and started examining her by asking a few questions. She had been found acting strangely by a railway track, so I began by asking her what had happened today. Then suddenly out of nowhere, I was being punched in the face and head. My instinct was to protect myself – I put my hands over my face while the punches continued. The psychiatric nurses who had been gossiping in the corridor pulled her off me and grappled her to the floor, while I ran into the next room, barely able to comprehend what had just happened. “She just hit me, she punched me in the head” was all I could say or think. And when I’d called my husband to collect me and take me home, my recurring though was simply, “She hit me”.
I was lucky in many ways that I suffered no serious damage, and as the assault happened the day before two weeks’ planned annual leave, I needed no time off work. My husband, however, was furious. He is not involved in healthcare, and he struggled to accept the fact that assault is a constant threat especially to front line staff (particuarly in A&E and psychiatry). He asked about why it happened, how this woman was able to carry on hitting me for so long before help arrived, and I didn’t really know what to say.
You see, we know the theory, but the infrastructure to protect NHS staff is just not there. My current surgery is a 1960s building, and security was clearly not a huge concern when it was built. The room and door layouts are in most cases designed for doctor and patient convenience rather than doctor safety. If I have a patient sitting in the chair next to my desk, they could if they wished pick up the chair and barricade me in my surgery and if I couldn’t reach my panic alarm I’d have to hope I was able to scream out and be heard. I wouldn’t be able to get past them as the room is only big enough for a desk, three chairs, an examination couch and a sink. When I read today’s article and started thinking about my assault I remember vowing to myself that I’d be constantly vigilant for ever more, about room layouts, security procedures and panic alarms, about protecting myself and protecting my colleagues. But time moves on and you become complacent, and try not to think about it too much. After all, it probably won’t happen to you. I think it’s time to think again.