“I’ve been hit in the head by a walking stick,” a primary care receptionist reported.
“A mother came in and was screaming and swearing at me because she couldn’t get an appointment for her daughters,” another receptionist reported.
“I’ve had people throw a bag of syringes at me because we don’t accept syringes,” said another.
Reports such as these are part of the literature supporting a review that finds patient aggression against receptionists is a serious safety concern for primary care offices and affects delivery of health care.
The review was published online in the BMJ’s Family Medicine and Community Health journal.
“Receptionists in general practice deserve evidence-based measures to improve their working conditions and well-being,” say the authors, led by Fiona Willer, PhD, of the Centre for Community Health and Wellbeing at the University of Queensland, Brisbane, Australia.
Though the study looked primarily at European and Australian practices, physicians in the United States say the incidences are familiar.
Cause often lack of access
Dr. Willer and colleagues point out that the root cause of patient regression is typically related to operational factors, such as inefficient scheduling or lack of access to the medical providers.
“However, reception staff are placed in the unenviable position of having to deal with the aftermath of the poor function of these systems without having the status or autonomy to overhaul them,” the authors note.
Authors analyzed 20 studies on aggression against receptionists.
Among the findings:
- All studies reported that patient hostility and verbal abuse of receptionists “was a frequent, routine, and relatively unavoidable occurrence in general practice.”
- Nine studies reported acts of physical violence toward receptionists, with all reporting that physical abuse occurred much less frequently than verbal abuse.
- Some acts were very severe, including being hit, shaken, held at gunpoint, stalked, and threatened with a razorblade.
The studies also discussed ways to prevent potential aggression or react to it, including:
- Regular staff training for managing patient aggression.
- Designing clinics with “safe rooms” and “cool down” spaces.
- Providing clear acrylic shields between receptionists and patients.
- Developing formal policy/procedure/protocol/action guides relating to management of patients.
Behavior can interrupt health care delivery
Carrie Janiski, DO, regional medical director at Golden Valley Health Centers in California, who was not part of the review, said she has seen the aggressive behavior the authors document in her practice’s lobby, “including yelling, name-calling, and threatening language or physical behavior.”
The instances disrupt health care delivery to the patient, who is often in crisis, and all patients and staff in the clinic, she said.
“The patient needs help and the aggressive way they are seeking it could cause harm to others or prevent them from receiving all the help they need,” she said.
She says in practices she has worked in, some effective mitigation strategies have included open-access scheduling, increased walk-in availability for appointments, de-escalation training for front-line staff, and office and exam room layout designed for safety.
She added that incident review is important and should include a process for patient dismissal from the practice.
Dustin Arnold, DO, an internal medicine specialist and chief medical officer at UnityPoint Health-St. Luke’s Hospital, Cedar Rapids, IA, said he agrees with the authors on the urgency for action.
“This is an urgent concern for practices across the country. Your receptionist is the face of your practice, and you should invest in them,” said Dr. Arnold, who was not part of the review.
He said he has seen “verbal abuse and generalized incivility” from patients against receptionists in practices where he has worked.
He said the measure the authors list that he thinks is most effective is staff de-escalation training.
“However, the best preventative measure is for the physician to be on time and minimize cancellation of appointments,” he said. “These are the two primary triggers of a patient becoming disruptive.”
He said his practice has installed a panic button at the front desk and built an alert into the electronic health record indicating that a patient has shown disruptive behavior in the past.
The authors conclude: “Staff training and protocols to manage patient aggression and ongoing structured staff support should be considered essential in general practice. Evidence-based strategies to prevent, manage, and mitigate the harms of patient aggression towards general practice reception staff are urgently needed.”
The authors and Dr. Janiski and Dr. Arnold declared no relevant financial relationships.