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.

[Analysis of violence against health care workers through medical surveillance at the workplace in a 8-yr period]

Physical and moral violence against the workers of a local public health unit is perspectively studied in the period 2005-2011. Data were collected during periodic medical surveillance of all workers exposed to risk and with more than one year of seniority. The prevalence of the phenomenon is constant in the period under review. On average, each year a worker in ten is physically assaulted, and one in five is subjected to verbal abuse. The professional groups most exposed to violence are nurses (OR 2.67 IC95% 1.63-4.39) and doctors (OR 2.44 IC95% 1.34-4.46). The areas at greatest risk are the psychiatric care (OR 25.7, IC95% 11.1-59.6) and emergency and first aid (OR 8.8, CI95% 3.8-20.5). The workplace violence against health workers requires urgent preventive interventions.

[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 with alcohol and drug addiction problems. Consensus Document of the Study Group on Hazardous Workers]

BACKGROUND

Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace.

OBJECTIVES

Occupational health traditionally addresses the issue of protection of worker from occupational hazards. The issue of protection of third parties from behaviour of workers resulting from drug and alcohol dependency implies an original methodological approach, involving full cooperation of employer, employees, and health and safety consultants.

METHODS

A consensus development meeting was organized under the leadership of the Italian Study Group on Hazardous Workers (La.R.A. group). The meeting brought together physicians of different specialties, legal experts and bioethicists, labour and management policy-makers, to discuss the issue and define the research data available, the standards that were appropriate, and which policies were fair.

RESULTS

The efficacy of medical surveillance, including workplace drug-testing, relies on a comprehensive policy, including written and verbal information on the use of alcohol and drugs on the job, training for supervisors and management, employee education, and employee assistance structures. Sample collection and testing should be carried out in accordance with standardized and tested procedures. Small businesses will need assistance, including development of model policies, setting up consortia for testing services and if necessary request for National Insurance benefits to reduce costs.

CONCLUSIONS

The recently introduced Italian legislation on occupational safety and health closely resembles Finnish law since it consists of a "double channel" for workplace drug testing. At recruitment, the employer is entitled to ask a job applicant for a certificate of "Job fitness", including drug tests, that can be issued only by a public health institution, where the job applicant works on a well-defined set of tasks which require accuracy, trustworthiness, independent judgement or a very good reaction capacity. The employer may also refer the employee to the public health institution to obtain a certificate in the course of an employment contract when there is a legitimate suspicion that the employee is working while under the effects of drugs or alcohol or that the employee is a drug addict. After recruitment, the physician responsible for medical surveillance of workers (the so-called "Competent Physician") is entitled to perform drug tests on employees. The need for a test is decided by the health care professional, not by the employer, and only a general report on the health of the employee ("fit", fit with restrictions" or "unfit") may be given to the employer. Workers positive for drug tests will be referred to a public health institution for re-testing and treatment.

[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.

[Critical aspects of the management of "hazardous" health care workers. Consensus document]

BACKGROUND

A worker is considered to be hazardous to others when, in the course of performing a specific work task, his/her health problems (e.g., substance dependence, emotional disorders, physical disability, transmissible diseases) pose a risk for other workers' or the public's health and safety, or begins to interfere with ability to function in profession life. The presence of certain illnesses or the fact that a health care worker is impaired because of them do not necessarily imply that he, or she, is hazardous for others. Working in health care increases the probability that an impaired worker being hazardous for others. Management of hazardous workers requires new techniques and procedures, and specific policies.

OBJECTIVE AND METHODS

An interdisciplinary group of experts from medical, bioethical, legal and administrative disciplines, together with trade union and employers' representatives, is currently attempting to define a way to put prevention measures into practice in accordance with state laws and individual rights.

RESULTS

A consensus document is presented, covering critical aspects such as: social responsibility of the employer, risk management, informed consent, non compliance, confidentiality, responsibility of workers, disclosure of risk to patients, non-discrimination, counselling and recovery of impaired workers, effectiveness of international guidelines.

CONCLUSIONS

Occupational health professionals are obliged to adhere to ethical principles in the management of "hazardous" workers; the assessment of ethical costs and benefits for the stakeholders is the basis for appropriate decisions.

[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.