Doctors are vulnerable to aggressive, demanding, abusive or even violent patients and feel ill-equipped to manage such consultations, according to a medicolegal survey.
Of 172 GPs and hospital doctors who responded to the Medical Defence Union (MDU) survey, more than half said they had been physically or verbally assaulted in the last five years.
While some of the respondents accepted this as "part of the job", more than half (100) said they had not received training in dealing with such situations and would like to feel more confident.
Examples of incidents include a doctor who had a hot drink thrown at her and a GP who was verbally abused and spat at. NHS figures reveal there were 54,758 physical assaults reported by NHS staff in 2008-9, including 3,472 in primary care.
Dr James Armstrong, an MDU medicolegal adviser, said the survey highlighted the need for more training for doctors in communication skills.
"Thankfully, only a small minority of patients are physically or verbally abusive or demanding to the point of aggression," he said. "The NHS has focused in recent years on trying to stamp out such behaviour and to protect NHS staff, for example with the establishment of the NHS Security Management Service.
"Of course there can be many reasons why a patient becomes violent or aggressive. Being ill can itself be the cause. Excessive waiting times and delayed appointments can turn frustration to anger and lead to violent outbursts.
"Distress, feeling that their concerns are not being taken seriously, disappointment at the lack of therapeutic success or guilt at not having brought a sick relative in earlier may also be factors in a person becoming aggressive."
Dr Armstrong added: "Unfortunately, many of the respondents to our survey reported that they had not received training in dealing with such distressing situations. There are steps doctors can take to try to prevent difficult situations escalating into violence or abuse, such as anticipating where flash points might arise."
Of the doctors surveyed who said they had been assaulted, around a quarter suffered anxiety or depression after the event. Four doctors needed medical treatment, for injuries such as cuts or lacerations.
Your comments (terms and conditions apply):
"All practice staff are at risk of verbal abuse and threat of physical attack for varying reasons. Staff should receive mandatory awareness training to help deal with mental health and substance misuse issues that can have a bearing on patient behaviour, along with general awareness of 'managing difficult situations'. Front of house staff who are the most vulnerable are the least likely to receive training that would not only improve their coping skills, but may ultimately protect them from physical harm" – Anne Care, West Midlands
"We too have our fair share of incidents, although most are directed at the non-clinical staff. While training is always helpful, it does not necessarily represent an actual incident. Removal from the practice list is always an option in extreme cases, although there is always the feeling you are merely passing the problem onto another practice" – Paul Blackhurst, Hull
"While actual violence is still quite rare, we do suffer from regular low-level aggression and disruption. At my practice we see rude behaviour, swearing at receptionists, shouting, intimidating patients leaning over the desk, patients refusing to leave consulting rooms and other such problems that may not amount to much individually but increase stress levels on a daily basis and put a strain on everyone. Neither doctors not staff are well equipped to deal with this" – Ed Hinde, Newcastle upon Tyne
"We have had training, but I must admit we could do to revisit it – a few months with no major incidents and it is possible to become complacent" – Name and address withheld