Australia: Confront risk of violence, doctors told

from Adam Cresswell, The Australian

Doctors should warn their colleagues – both in their own rooms and in nearby practices – about potentially violent patients who they believe may pose a safety risk.

That idea is controversial among doctors – and may court conflict with privacy laws – but Victorian GP Leanne Rowe says it’s vital to counter the rising threat from patients who, for whatever reason, target their doctor or other health workers with violent and even lethal force.

That is what happened to Melbourne GP Khulod Maarouf-Hassan, a 51-year-old mother of three who was stabbed to death by a patient in her Noble Park consulting room on June 16 2006. Associate Professor Rowe – who knew Maarouf-Hassan well – says the murder “stopped the heart of the medical profession”.

A man, understood to have been attending the surgery as a patient, was subsequently charged and the case is pending in the Victorian Supreme Court.

Armed with a $200,000 grant from the federal health department, Rowe is putting the finishing touches to a national education program for GPs that will aim to help them not only reduce the risk of such events occurring in their own practices, but deal with it more effectively if they ever do.

Rowe says one of the aims is to encourage every medical practice to have a standardised response to a ‘code black’, which is the hospital term for procedures that swing into place to deal with an armed assault.

“Private medical practice is lagging behind the Australian public hospital system in its response to occupational workplace violence,” Rowe says.

“And the Australian health system is lagging behind what’s happening internationally, particularly in the UK. We have to come in line with the 21st century.”

The education program, which will be available from June this year, will come in the form of a booklet that includes tools to allow GPs to conduct safety audits of their own practices.

There will also be educational material that can be implemented either by divisions of GPs – locally based organisations that organise educational events and other services – or individual practice managers.

Another element will be a “check program” aimed at GP registars, as Rowe says this group is particularly vulnerable because in moving from practice to practice for new rotations, they are less familiar either with local patients or practice protocols.

After the 2006 murder some other practices nearby reportedly considered installing bullet-proof glass and other security measures.

But Rowe says it’s time to lift some taboos and consider that a simple step that can reduce the risk of violent incidents is for doctors to bear in mind the groups that pose the biggest threat.

“There’s a trend here – it’s usually young men with untreated psychotic illness, who abuse alcohol and other drugs and have very disordered thinking,” Rowe says.

“Medical practitioners have been very reluctant to talk about the risk of violence associated with mental illness, because we recognise that most people with mental illness are at risk of being victims, rather than perpetrators of violence – and they don’t want to add to the stigma.”

Identifying patients to other doctors, even within a practice but particularly to doctors or other outside it, for reasons not related to that patient’s medical needs is another taboo.

But Rowe says the Medical Practitioners’ Board of Victoria has been “very supportive” of the proposals to encourage doctors to circulate details of potentially violent patients more widely.

Rowe likens it to a “neighbourhood watch scheme for the medical profession” and says medical boards in other states will now also be approached to ensure the push does not run into trouble.

Rowe concedes the proposal will “challenge some people” but argues that niceties around privacy no longer amount to a valid objection, and that Maarouf-Hassan’s murder was “a wake-up call to every medical practitioner in Australia”.

“I think we need to develop a system of flagging some patients who are potential perpetrators,” she says.

“Medical workplace violence is massively under-reported. We have a culture of not talking about it.”
Rowe was chairman of the Royal Australian College of General Practitioners at the time of Maarouf-Hassan’s murder.

“As a doctor, I have experienced many tragedies, but I think the saddest moment of my career was giving a eulogy at her funeral in front of 1000 grieving people beside her open coffin,” Rowe says.

“Unfortunately until now, the debate within the medical profession has been very limited and has been around alarm systems and CCTV.

“But we need to go way beyond this sort of limited thinking. Medical workplace violence is really the tip of the iceberg of increasing violence in the community, and medical practitioners have a responsibility to respond to this issue.”