Interview on violence in doctor’s offices: “Sometimes it has nothing to do with us”

The German Medical Association speaks of a “brutalization in the way medical personnel are treated.” General practitioner Maria Hummes has rarely experienced violence in her practice – but has observed increasing egoism among patients.

tagesschau.de: The German Medical Association reports that there is a brutalization in the way medical staff are treated. Can you share these observations?

Maria Hummes: By the way, I don’t think this is so common in GP practices because it is the area that still relies most on personal relationships. Physical violence is a big exception for us – we’ve only had it two or three times in the 23 years I’ve been in practice. But what you can see is that verbal outbursts are more common than they used to be.

De-escalating Tone among employees

tagesschau.de: What was the most serious situation you have experienced in practice?

Hummus: About five years ago, one of them got really abusive and broke a mirror and a chair. He attacked us, but we were able to calm him down with de-escalation measures so that no physical harm was done. But it was pretty intense – the most dangerous situation I’ve ever experienced.

Overall, we try to establish a de-escalating tone among our employees. This has worked relatively well so far. We simply have a great team that ensures that things don’t escalate from the outset. If they notice that a critical situation could arise with a patient, they always go into the treatment room in pairs.

Police station five minutes away

tagesschau.de: You just mentioned de-escalation measures – how is the practice team trained for this?

Hummus: My colleague, with whom I have worked for a long time, and I are both psychotherapists. This means that we have many years of training, for example in the area of ​​conversation skills. We also do training with our employees for situations like this and team meetings in which we go through critical cases again.

We also have the advantage that the police station is only five minutes away. So it’s clear that if we call now, the police will come straight away. And aggressive patients will be banned from the premises.

Desire for more painkillers

tagesschau.de: Andreas Gassen, head of the statutory health insurance doctors’ association, has said that many patients have “a skewed assessment of the urgency of their own treatment.” What were the triggers for the incidents in your practice?

Hummus: In our acute consultations, we also experience discrepancies in assessment. But unlike in emergency care, in the general practice sector, we rely on long-term relationships: we know our patients, and they trust us.

What often leads to conflicts is the desire for narcotics. This can be the case, for example, with junkies who are certainly also chronically ill, but who want more or different painkillers than those we can support from a medical point of view.

Endless diagnostics on the Internet

tagesschau.de: You said at the beginning that you have also experienced verbal outbursts on several occasions. What kind of cases are these?

Hummus: Some patients have specific ideas about what tests they want to have and then put pressure on others. The problem is that there is an infinite amount that can be done in medicine and that there is an infinite amount of diagnostic information for certain symptoms on the Internet.

But we base our diagnosis on the therapeutic decisions. If someone requests an MRI of their knee but never wants to have an operation anyway, then the MRI is not that important at first. The next steps are usually the same regardless of the MRI. But if the expectation is: ‘If my knee hurts, I have to have an MRI’, then this can lead to an argument.

But if I know the patients well, then they also know that if I really need something, then I will get it. And I can also explain to them that we do not have unlimited resources at our disposal. If everyone could always have everything done, then our health system would not be able to finance it.

And one’s own needs are often perceived much more strongly than the context: all the examinations use energy, create waste and cost money. You have to keep that in mind these days when you make decisions as a doctor.

Burden for Employees at reception

tagesschau.de: Who suffers most in situations where such failures occur?

Hummus: This is a significant burden for our reception staff, who always have to listen to everything. That’s why we try to do a lot to ensure that it doesn’t have too much of an impact on their work situation.

Maintain professional distance

tagesschau.de: And what does that do to you as a doctor in your everyday life?

Hummus: As a psychotherapist, I have learned to maintain a professional distance. The learning phase was difficult, but now I don’t feel personally attacked by it because I know that it is due to the situation and has nothing to do with me personally.

Patients under pressure

tagesschau.de: Do the patients who become particularly aggressive have something in common?

Hummus: I can’t say that it’s just men or just women. Social background isn’t important either. I think they’re people who are under pressure, regardless of the reasons.

Sometimes it has nothing to do with us. Maybe it was a bad day at work, you got bullied by your boss and then you don’t get that stupid treatment. Then the threshold is reached and an outburst occurs. But the more relaxed someone is, the less inclined they are to bang on the table in a rude manner.

Fewer Community structures

tagesschau.de: How do you explain then that aggressive behaviour has increased in recent years?

Hummus: I believe that there are far fewer areas in which social interaction is practiced. People move around on their internet platforms and in their mobile phone world, there are fewer community structures. I believe that we should focus more on social responsibility in this area in order to flatten the mentality of ‘I’m the one who matters and I have to assert myself against everyone else’.

Don’t just move in your own bubble

tagesschau.de: What do you think can help against such aggression?

Hummus: What always helps is when people learn to talk to each other again, to have community experiences – from a wide variety of contexts. When people don’t just move in their own bubble, but when social dialogue is encouraged.

And maybe learn how to argue, learn that conflicts can be resolved. Social responsibility is very important to our society.

The interview was conducted by Melisa Job for tagesschau.de