Violence against radiologists. I: Prevalence and preventive measures

PURPOSE

Violence in the workplace is a specific risk for healthcare workers. Radiologists, especially when involved in emergency services, share that risk. Very few studies in the literature have researched this topic. This study aimed to evaluate the prevalence of violent behaviour in a large sample of Italian radiologists and analyse the phenomenon and its consequences with a view to proposing preventive measures.

MATERIALS AND METHODS

A total of 992 radiologists (61.5% men) taking part in a national radiology congress agreed to respond to a questionnaire on violence that contained the Violent Incident Form by Arnetz for the description of violent incidents in healthcare practice.

RESULTS

Some 6.8% of radiologists in public hospitals experienced physical abuse in the previous 12 months, for the most part from patients or their companions. The prevalence of physical abuse is greatest among younger healthcare individuals with less clinical experience, with no differences between sexes. Among younger radiologists, one in five suffered at least one act of physical abuse in a working year. Nonphysical violence is more widespread and throughout radiologists' working lives affects 65.2% of them. In this case, almost half of the violent incidents originate from colleagues. A total of 5.5% of respondents stated that they were victims of abuse at the time of the survey. In most cases, the violent incidents remain unreported. The immediate consequences of violence in the workplace are emotions such as anger, disappointment, humiliation, anxiety, fear, distress, a feeling of helplessness and isolation, occasionally a feeling of guilt or of having done wrong and a desire to take revenge, change behaviour or change workplace.

CONCLUSIONS

The extent of the problem calls for the adoption of a series of measures aimed at eliminating the causes of the various forms of workplace violence.

[Influence of environmental discomfort on musculoskeletal disorders]

Musculoskeletal disorders (MSDs) are common among hospital workers. This cross-sectional study on 1744 hospital workers showed strong interaction between temperature complaints (OR 2.73), other environmental complaints (OR 3.12) and upper limbs disorders. A significant interaction between temperature and strain for upper limbs disorders (F = 9.52, p = 0.023) was also found. Environmental and psychosocial factors can interact increasing significantly the risk of MSDs.

Ethical problems in radiology: medical error and disclosure

In radiological practice, as in any medical activity, errors are inevitable despite being foreseeable and preventable. The approach to managing medical error and relations with patients prompt the need for resolving the ethical dilemma arising from conflicting legitimate interests. The solution to this dilemma is particularly complex in an environment in which the tendency to sue physicians for civil liability or incriminate them for criminal liability appears to be particularly high. The disclosure of error is undeniably useful in raising patient awareness, reducing their suffering, improving the quality of care and limiting the consequences of the damage. There does not appear to be any evidence to suggest disclosure modifies the probability of litigation against the physician.

Work stress in radiologists. A pilot study

PURPOSE

We studied occupational stress and its psychosocial effects in a sample of Italian radiologists and radiotherapists:

MATERIALS AND METHODS

Radiologists and radiotherapists attending two medical conferences were invited to complete a questionnaire comprising four sections investigating the risk of occupational stress (organisational discomfort, Karasek's Job Content Questionnaire, Siegrist's Effort-Reward Imbalance, Warr's Job Satisfaction) and four sections investigating the health effects of such stress (Goldberg's Anxiety and Depression Scales, General Health Questionnaire, Lifestyles Questionnaire).

RESULTS

Radiologists and radiotherapists generally expressed high levels of control, reward and satisfaction. However, 38.5% complained of severe organisational discomfort, 24% reported job strain, 28% reported effort/reward imbalance and 25% were dissatisfied. Female radiologists and radiotherapists showed higher levels of organisational discomfort than their male colleagues. Younger and less experienced radiologists and radiotherapists had higher strain scores than their older and more experienced colleagues. A significant correlation was observed between stress predictors and the effects of stress on health, including depression and anxiety, psychological distress and unhealthy lifestyles.

CONCLUSIONS

Radiologists and radiotherapists are exposed to major occupational stress factors, and a significant percentage of them suffer from workplace stress. A special effort is required to prevent this condition.

[Workers risky for others on the Web]

Hazardous workers (HWs) are they who, depending upon their pathologic conditions, ageing or addictive behaviour, may pose at risk the safety and health of their colleagues, customers, and other people. Physicians charged of the medical surveillance of workers (Competent Physicians, CPs) are called to assess fitting for work of HWs. The aim of this paper was to analyze the frequency of debate about HWs in the online forums of the Italian CPs' website. Results show that there is growing attention on the HWs issue. Different stakeholders are involved, and some ethic dilemma are posed. A systematic approach to the problem, and the formulation of guidelines for CPs, is highly desirable.

[The physician with a reduced work ability]

The occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired physicians. Some "red flags" may be observed during medical surveillance of workers, and this should elicit the suspect that the colleague is impaired by chemical, psychiatric, or neurological disease. Three emblematic cases are discussed. While English-speaking countries have faced the problem since the 70's, Italy currently lacks policy to deal with impaired physicians.

[Stalking in work environment]

Stalking is a form of interpersonal victimization that can have irrevocable effects on the lives of victims but is frequently misunderstood and minimized. This article presents a case study of a woman who was stalked in the workplace by a 39-year-old male colleague, and offers recommendations for occupational health clinicians charged of medical surveillance of workers (so-called "Competent Physicians") who have to cope with stalking at the workplace. The prevalence of stalking provides many opportunities for Competent Physicians to intervene, but first they must recognize and understand the problem. The study underlines the inadequacy of the current legal and medical responses to the needs of these victims.

[Identification and control of workers that pose a risk to others in the health field]

BACKGROUND

Working in health care increases the probability that an impaired worker be hazardous for third persons.

METHODS

A literature review concerning identification, intervention, and treatment of hazardous health care workers is here reported.

RESULTS

Published reports of health care worker-to-patient transmission of bloodborne infections, and papers concerning the so-called "impaired physician", have been reviewed.

DISCUSSION

According to European directives on workers' health and safety, the occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired professionals.

CONCLUSIONS

Strategies for early identification, treatment and rehabilitation of impaired physicians are reviewed and suggestions for preventive action are given.