We like to thank our colleagues Weiß and Günther for their contributions. The account of Weiß shows that the issue of aggression and violence is definitely not limited to primary care physicians, but also affects medical assistant staff.
The uncertainties and errors of judgement with regard to the legal basis for coercive measures as an important source of violence in the healthcare professional–patient relationship does certainly apply to the interface between primary care physicians and paramedics as these measure are frequently a cooperative effort. However, as coercive measures are rarely taken in a primary care setting, the overall impact of other factors is likely to be critical. It is unfortunate that there is still a lack of research into what actually triggers aggression and violence against primary care physicians in Germany, making it impossible to draw any scientifically based conclusions.
The data from Braunschweig provided by Günther (1) in combination with the study by Schmidt (2) and our own survey show that aggression and violence against paramedics and primary care physicians represent a problem which has received little scientific and organizational attention despite the fact that it regularly occurs. Therefore, we support the view of Weiß that the issue should not be “kept secret out of shame“. Instead, further research (e.g. into the causes, triggers) is desirable, and strategies to tackle the problem (e.g. as part of continuous medical education and advanced training or by providing drivers for on-call duty call-outs) are urgently required.
Dr. med. Florian Vorderwülbecke
Technische Universität München
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Günther A, Schellberg P, Beykuffer CH, Malchau T, Hanne M: Umgang mit behandlungsunwilligen Patienten. Rechtliche Grundlagen klären. DGUV faktor arbeitsschutz 2013; 41: 18–20.|
|2.||Schmidt J: Gewalt gegen Rettungskräfte – Bestandsaufnahme zur Gewalt gegen Rettungskräfte in Nordrhein-Westfalen: Juristische Fakultät. Ruhr-Universität Bochum 2012.|
|3.||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 MEDLINE|