Bamgbade Olumuyiwa Akinwumi, Sonaike Monisola Temidayo, Adineh-Mehr Leili, Bamgbade Daniel Olutosin, Aloul Zaina Samir, Thanke Cherith Boatametse, Thibela Thakgalo, Gitonga Grace Gaceri, Yimam Genet Tadesse, Mwizero Aria Genaelle, Alawa Fidelia Batombari, Kamati Lahja Omagano, Ralasi Nolubabalo Patience, Chansa Mwewa
University of British Columbia, Vancouver, Canada.
Salem Anaesthesia Pain Clinic, Surrey, Canada.
Anesth Pain Med. 2024 May 5;14(2):e144263. doi: 10.5812/aapm-144263. eCollection 2024 Apr.
Patients with chronic pain often experience psychological issues. They may also exhibit harassing behaviors toward healthcare staff. This complex sociomedical issue necessitates increased attention.
This study analyzed incidents of staff harassment caused by chronic pain patients. It examined the characteristics of chronic pain patients who harassed clinic staff, as well as the causative or associated factors. The study also explored the management and outcomes of these harassment incidents.
This prospective observational study involved 1102 chronic pain patients who received treatment at a pain clinic. Data were prospectively collected on patients' gender, age, ethnicity, occupation, injury insurance claims, and incidents of staff harassment caused by patients.
Pain clinic staff were harassed by 121 patients (11%). Among the harassers, females constituted 70.2% and males 29.8%. Additionally, 50.4% of the harassers were unemployed, with unemployed patients causing more staff harassments (P = 0.001). A significant portion, 86 %, of the harassers had injury insurance claims and were associated with a higher incidence of staff harassments (P = 0.002). Patients making disability insurance claims also caused more staff harassments (P = 0.001). Among the harassers, 50.4 % demanded higher drug doses, and 50% did not have regular primary healthcare providers. The types of harassment included insults (34.7%), threats (19.8%), retaliations (3.3%), and sexual harassment (42.2%). All cases of sexual harassment were addressed; the patients involved were counseled. Most harassment incidents were resolved through tactful communication. Of the harassers, 9.9 % were discharged from the clinic.
Harassment of pain clinic staff by chronic pain patients is significant. This sociomedical issue may be worsening due to factors such as opioid misuse, racism, the pandemic, and socioeconomic challenges. While most chronic pain patients are reasonable, some can be challenging. This study confirmed that the majority of patients who harassed staff were female, unemployed, had made injury insurance claims, and demanded higher drug doses. Abusive patients should receive anxiolytic therapy, behavioral boundaries, counseling, distraction therapy, and empathy. Pain clinics should implement staff training and support programs to protect staff from harassment. Additionally, pain clinicians should establish peer support networks to mitigate the psychological impacts of patient aggression and maintain professional well-being.
慢性疼痛患者常伴有心理问题。他们还可能对医护人员表现出骚扰行为。这一复杂的社会医学问题需要更多关注。
本研究分析了慢性疼痛患者导致的医护人员骚扰事件。研究了骚扰门诊工作人员的慢性疼痛患者的特征，以及相关因素。本研究还探讨了这些骚扰事件的处理方式及结果。
这项前瞻性观察研究纳入了1102名在疼痛门诊接受治疗的慢性疼痛患者。前瞻性收集患者的性别、年龄、种族、职业、工伤保险索赔情况以及患者导致的医护人员骚扰事件数据。
121名患者（11%）骚扰了疼痛门诊工作人员。在骚扰者中，女性占70.2%，男性占29.8%。此外，50.4%的骚扰者失业，失业患者对工作人员的骚扰更多（P = 0.001）。很大一部分（86%）骚扰者有工伤保险索赔，且与更高的工作人员骚扰发生率相关（P = 0.002）。提出伤残保险索赔的患者对工作人员的骚扰也更多（P = 0.001）。在骚扰者中，50.4%要求增加药物剂量，50%没有固定的初级医疗保健提供者。骚扰类型包括侮辱（34.7%）、威胁（19.8%）、报复（3.3%）和性骚扰（42.2%）。所有性骚扰案件都得到了处理；对相关患者进行了咨询。大多数骚扰事件通过巧妙沟通得以解决。在骚扰者中，9.9%被门诊开除。
慢性疼痛患者对疼痛门诊工作人员的骚扰情况严重。由于阿片类药物滥用、种族主义、疫情和社会经济挑战等因素，这一社会医学问题可能正在恶化。虽然大多数慢性疼痛患者是通情达理的，但有些患者可能具有挑战性。本研究证实，骚扰工作人员的患者大多为女性、失业、有工伤保险索赔且要求增加药物剂量。有攻击性的患者应接受抗焦虑治疗、行为界限设定、咨询、分散注意力治疗和共情治疗。疼痛门诊应实施工作人员培训和支持项目，以保护工作人员免受骚扰。此外，疼痛科医生应建立同伴支持网络，以减轻患者攻击行为对心理的影响，维护职业幸福感。
