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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 September 8; 335(7618): 516.
PMCID: PMC1971174
From the Frontline

Patient safety

Des Spence, general practitioner, Glasgow

A colleague is stabbed a few miles from where I work. Thankfully she is alive and I hope that she will make a full recovery. Our thoughts are with her family and friends. I feel sadness and anger in equal measure that these things should happen. Then predictably and selfishly I fret about my own vulnerability, and “what ifs” pace the floor of my consciousness. Irrespective of where you work, general practice is harsher than many people believe—a small firm for printing antibiotic prescriptions and sick notes before golf it is certainly not.

We live in a polarised world in which medicine is often the only interface with society's forgotten people. Family medicine is the lowest common denominator where all of society's woes are legally dumped. Amid the debris there are medical emergencies and diagnoses to be made. I like it, but it is not for everyone.

The inner cities in particular are a distillation of debilitating ailments, heaped together in highrise concrete cages of social housing. Addiction, poverty, unemployment, and chronic mental problems—the most vulnerable people are left exposed to the elements. Violence is endemic in this environment and is seen a legitimate form of communication.

GPs are literally at the frontline. I have been threatened, had a hammer pulled on me, been shown knives, and been chased by a gang while on a house call. Instinctively and constantly I scan for those non-verbal cues of aggression—the narrowing of the eyes, the intake of breath, and the change in body stance. Long ago I learnt never to raise my voice and to steer well clear of the rocks of direct confrontation. My experience is common to many GPs.

Our practice's panic button system is only ever activated by children while I am distracted by their ill parents. The only response is a stampede of panic in the reception area. Pressing the panic button is perhaps the last thing I would consider, as this merely ups the stakes. Courses in dealing with violence and abusive patients are a health and safety tickbox affair, unrealistic and offered by those who have no insight into our working environment.

So how to protect us? Tougher sentencing may feel like more justice but would not deter attacks. More security may make GPs feel safer but would not prevent the determined nor the random attacker, and we would lose our greatest strength—accessibility. As doctors we have to accept the unacceptable—that we live in a violent society. No well chosen soundbite or magic pills can heal our violently sick society. We are so obsessed with the unimportant, and we are blind to the fundamental similarities and collective values that we share. The solution is simple but difficult—to put others before oneself. This is the only way to re-establish the protection that is community.

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