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'A knife was pulled on me for refusing a prescription': GPs want more protection from violent patients

A union representing GPs say there’s been an increase in the number of attacks on their members over the past several years; GPs want the HSE to put a process in place to protect staff and patients.

shutterstock_754554070 Source: Wutzkohphoto via Shutterstock

Over the years, I’ve had a knife pulled on me, graffiti spray canned on the wall of my building [saying] ‘I know where you live’. I’ve actually had a firearm discharged at me by an elderly farmer – thank God it was a fair distance away.

A UNION REPRESENTING GPs has written to the HSE to demand a process to deal with violent and abusive patients – claiming that the number of dangerous incidents against its members is increasing.

The National Association of General Practitioners (NAGP) has criticised the HSE for not implementing a procedure for such patients, which puts GPs, their staff and other patients at risk.

It accuses the HSE of moving patients who have been reported as violent “from one parish to another” and hiding their history of abuse from GPs. TheJournal.ie has learned that some GPs resort to handing out prescriptions, against their medical judgement, after being threatened by patients.

Currently, a patient can be assigned to a GP’s panel of patients but little information is given about their history, meaning if a patient has been violent or threatening with a doctor previously, and is removed from his/her panel, the next GP isn’t given forewarning.

“What happens is you just suddenly find, when you look at your listings that a patient has been assigned to your panel. There’s no history, there’s no handover, and as far as the HSE is concerned this person is your responsibility,” says Dr Emmet Kerin, president of the NAGP.

“So this person, you don’t know who they are, they’ve been assigned to your panel. It goes back to the whole move a guy to a different parish thing.”

He says it’s “completely unsafe” to be assigned patients who are violent offenders, or who have drug-seeking behaviour or psychiatric issues, and not to be informed of those factors.

Dr Michael McConville, who runs a clinic in Co Cavan, says he’s had multiple experiences of violence in his 30 years of practising, and faces harassment on a daily basis.

“Most of it takes the form of shouting, cursing. ‘I’m going to come down there and sort you out’, or ‘I’m going to complain about you’.”

He’s had a gun fired at him, threats written on the building where he works, and a knife pulled on him.

“Someone pulled a knife on me because I wouldn’t give them a prescription. I don’t know if they intended to use the knife – they pulled the knife out and when they saw that I didn’t show any fear, they didn’t use it.”

shutterstock_648034384 Source: Matt de Lange via Shutterstock

He told TheJournal.ie that he’s seen a marked increase in the number of violent or abusive incidents in the past five to 10 years.

“On Wednesday, a guy was stopped by the guards because he had no seatbelt on and they gave him a ticket. And he arrived into our surgery half an hour later demanding a letter off me saying he was exempt from wearing a seatbelt.

“He wasn’t exempt from wearing a seatbelt. He had no reason to be exempt from wearing a seatbelt. And when we refused to give him it, it took us half an hour to get him out of the building. It was only when we said we were going to call the guards that he left.”

He said the man was shouting and cursing as he was leaving.

It’s terrible for patients to watch that. Patients get upset because you’re upset, your staff are crying, you have to let them go for the day – this is a regular occurrence. I would say almost an epidemic.

When asked whether some GPs would feel obliged to give prescriptions to patients who are threatening, McConville says “absolutely, there’s no question about that”.

I know doctors, I haven’t done it myself, but I know doctors who have done it and then they phone pharmacists saying ‘Don’t dispense this’. It’s to get them out of the building.

What’s the process?

Dr Emmet Kerin, president of the NAGP, opened a practice in Limerick city in 2012.

He says that in his experience, it could take between three to six months for a patient to be removed from a GP’s panel, despite the official wait time being set at four weeks. In the meantime, they’re still obliged to provide care for that same patient.

“If you really push it, you’d be on the phone, you’d be ringing, faxing, constantly trying to get someone to do so.”

The patient is then assigned to another GP’s panel by the HSE, but the reassignment happens without any procedure or reprimand for the patient, which he says leads to a cycle of offences from patients with violent tendencies.

“When a person is allocated to you, it’s basically a piece of paper about three sentences long, so you don’t know who they were previously with, you don’t know anything about them. And then they turn up and do the same thing all over again.”

In response to a query from TheJournal.ie on what the process is for dealing with patients who have violent or abusive tendencies, the HSE gave the following statement:

When a patient is transferred from one GP panel to another, there is provision for the transfer of medical records to the receiving GP and provision for direct communication in cases of an exceptional nature.

The HSE were also asked to provide figures on the number of violent incidents against GPs for 2016 and 2017, but these were not available at the time of publication.

There has been a significant increase in attacks on mental health staff in the past five years: from 6 reported attacks in 2012 to 149 reported attacks so far this year.

According to figures for last year released to the Irish Examiner, around 600 HSE staff are assaulted by patients each year.

Comparison with the UK

The NAGP has called on the HSE to provide designated healthcare centres for patients with a history of “aggressive outbursts” against GPs.

In 2000, similar facilities were introduced in the UK where public healthcare facilities with trained staff, appropriate procedures and security were put into place. This short piece from the Guardian gives an example of such a facility, which references CCTV cameras in the waiting room and furniture pinned to the floor.

While it could take several months to remove a patient from an Irish GP’s panel, the British Medical Association says that UK GPs can have a patient removed from their panel within a timeframe of eight days (and less if the removal is due to a violent incident).

In Ireland, Kerin says doctors are responding to violent patients in their own way – adding that it’s thanks to his “quick feet” that he hasn’t been injured by a patient in his practice.

“These incidents happen quite frequently and out of the blue,” McConville says. “We don’t know how to manage them, most of my patients are pretty elderly people who are fairly sick – for them it’s horrible.”

In the meantime, the lack of process or accountability is having a real effect on GPs, their staff and their families.

“There are times when you come home and you tell your family about your day and your kids get frightened. They ask ‘why is this happening?’”

Read: Health minister says the €60 price tag to see a GP is too expensive

Read: Leo Varadkar suggests consultants should ‘clock in’ to ensure they’re at work

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