You’re in the middle of a typical shift when a patient starts yelling at one of the nurses. You rush to help your colleague when the patient then starts yelling at you. There is no other doctor to treat this patient. What do you do? Is your action any different if the patient physically assaults you or your staff?

Violence in the health care setting is a disturbing reality and a growing problem.⁷ The unique environment of the emergency department, where all comers are cared for and acuity and emotions run high, lends itself to a higher incidence of patient aggression than most other hospital departments.⁵ A 2006 survey of emergency department employees found that in a six-month period, the 242 employees surveyed experienced 319 assaults perpetrated by patients, and that most workers had been verbally harassed by patients or visitors.³ Other studies found similar trends.^5,8,10

Often, when verbally or physically assaulted, what you want to do and what you must do are not the same. Ethically, you are bound by the medical oath to help those who seek your care. But how do you separate your feelings from your actions and deliver good care to someone who has attacked you or your staff? What is your responsibility as a provider to care for this patient?

Caregivers may find it difficult to deliver excellent care in such circumstances. Indeed, ACEP policy states, “optimal patient care can be achieved only when patients, health care workers, and all other persons in the emergency department are protected against violent acts occurring within the department.”¹

Many times, the violent patient is intoxicated or has psychiatric issues. Sometimes the patient or family is reacting to the stress of being in the emergency department. The emotional trauma, feelings of danger and insecurity this type of violence causes can compromise the well-being of other patients and visitors. Violence in the emergency department makes other patients feel unsafe and reduces the quality of their care due to the disproportionate allocation of resources and personnel to attend to the violent patient.

The exposure to violence in the workplace can also contribute to burnout. It may result in emergency department personnel suffering fear, anxiety, self-doubt, and even post-traumatic stress disorder.^3,5,9

Often, emergency department staff might think that verbal and physical violence is just part of the job. But if you change the setting to a doctor’s office or retail store, no one would accept violence toward them as part of their job. Why is it OK in the emergency department? There exists a mind-set that to be abused by patients or their visitors is something to which emergency physicians should be resigned. In contrast, ACEP policy states that emergency physicians have a duty to oppose violence and to “protect themselves, staff, and patients from violence.”¹ Most emergency care workers have either been assaulted or been threatened with violence at some point, and have developed their own de facto idea of best management, which likely falls somewhere in between these two opposing paradigms.