GOT YOU: Frontline staff at AH are taught self-defence. Here, corporate communications officer Nur Diana Jamaludin, 29, practices a disarming technique on security officer Suhaimi Hannari, 41. -- ST PHOTO: MUGILAN RAJASEGERAN

Then he said to the two terrified Alexandra Hospital (AH) employees attending to him: 'I cannot live anymore and I cannot guarantee I will not kill people.'

The man was eventually pacified, and left. He was later arrested and jailed.

That incident last year prompted hospital administrators to start aikido classes for frontline staff so that they can defend themselves.

The parang incident is an extreme case of patient violence, but some hospitals say frayed tempers have become more common.

Most of the abuse levelled at hospital staff is verbal, but there have been occasions when they were slapped or hit, or had objects thrown at them.

Singapore General Hospital (SGH) recorded nine altercations between staff and patients and their next-of-kin in 2005. This shot up to 74 last year. National University Hospital (NUH) had 25 such cases in 2006, but this went up to 61 last year.

AH had 74 cases last year and 20 in the first four months of this year.

The abuse tally for all hospitals last year, including Tan Tock Seng (TTSH) and Changi General, was 234.

SGH director for communications and service quality Tan-Huang Shuo Mei reports a 'worrying trend of demanding and unreasonable patients and their next-of-kin who appear to have little respect for health-care workers'.

But most are loath to take further action. As a nurse who has worked for four years put it, 'patients are sick and they are often confused by the pain or the condition'.

Foreign nurses have even been subjected to racist remarks.

Said TTSH nurse manager Christopher Soh: 'Sometimes patients or relatives pick on my staff and tell them, 'You don't know what's happening here so go back to your country, don't work here!''

There is no single explanation for the higher level of discord, but long waits to see a doctor and a shortage of hospital beds are cited as reasons.

Some patients' families think they know better what sort of treatment their loved ones should receive. Or they are set off by an employee's choice of words.

Then there are those who insist on getting waivers, compensation or more benefits.

Consultant psychiatrist Adrian Wang explained the 'sick role' that patients subconsciously adopt when ill.

'There is a set of expectations here, such as 'I'm ill so I'm allowed to moan and groan a bit',' Dr Wang said.

Hospital staff have help dealing with ill-tempered patients. At Changi General, security officers and some nurses learn unarmed combat.

When things get too hot to handle, in-house security officers are summoned.

Said Mr Toh Cheng Onn, the security manager at AH: 'Most nurses are women and if the aggressive patient is a man, they would need help restraining him,' he said.

And when do the police get called? When a patient starts wielding a bedpan as a weapon.

joolin@sph.com.sg

juditht@sph.com.sg