The article of Vorderwülbecke et al. deals with the important topic of prevention of violence. It arrives at the conclusion that severe types of aggression are of concern, especially at house/home visits during on-call duty. The authors hold the view that in this respect a comparison with the experiences made by the emergency medical services may be warranted. (1) This comparison could reveal further strategies for the prevention of violence.
For the emergency medical services of the city of Braunschweig, Germany, severe violence was defined as violence resulting in several days of incapacity for work after a physically violent attack. Three such cases were identified during the period of one year (2). This is in line with the quality and frequency reported by Vorderwülbecke et al. (1). Uncertainties and misunderstands with regard to the legal basis of coercive measures have been identified as a main source of violence in the healthcare professional–patient relationship (2). This applies to the use, and, more so, omission of coercive measures. At times, an obligation to render assistance is perceived despite the fact that such assistance cannot be reasonably expected, even when taking into account the guarantor status. Typically, a legal obligation to enforce certain measures against the patient’s will is assumed, even though the patient has the right to reject such measures. These errors in judgement promote violence. They occur among both paramedics and emergency physicians.
I believe it is likely that legal uncertainties regarding the use and omission of coercive measures do exist and contribute to the occurrence of avoidable violence for physicians during on-call duty as well. Future research into this topic should include the connection between legal uncertainty and violence. This could help to identify strategies to increase the safety during house/home visits made while on on-call duty.
A pragmatic interpretation of the relevant legislation and consistent respect for patient rights may contribute to the prevention of violence in the healthcare professional–patient relationship.
Dr. med. Andreas Günther
Stabsstelle Ärztliche Leitung Rettungsdienst
|1.||Vorderwülbecke F, Feistle M, Mehring M, Schneider A, Linde K: Aggression and violence against primary care physicians—a nationwide questionnaire survey. Dtsch Arztebl Int 2015; 112: 159–65 VOLLTEXT|
|2.||Günther A, Schellberg P, Beykuffer CH, Malchau T, Hanne M: Umgang mit behandlungsunwilligen Patienten. Rechtliche Grundlagen klären. DGUV faktor arbeitsschutz 2013; 41: 18–20|