Abusive patients risk being discharged from hospital amid growing number of abuse cases

More than two in three healthcare workers had witnessed or experienced abuse in the past year. PHOTO: ST FILE

SINGAPORE - Patients who abuse healthcare workers may soon find themselves discharged from medical care by the hospital, if they do not need urgent care.

Caregivers and visitors who abuse and harass medical staff may also be stopped from entering the premises the next time they try to visit, as healthcare institutions in Singapore take a zero-tolerance stance on the abuse and harassment of staff.

These recommendations, by a tripartite workgroup that looked into the issue, come amid a high number of such cases, with about one in three nurses, pharmacists and other workers in the sector either witnessing or experiencing abuse or harassment at least once a week.

Other recommendations made by the Tripartite Workgroup for the Prevention of Abuse and Harassment of Healthcare Workers include issuing a warning and refusing unreasonable requests.

The workgroup, comprising representatives from the Ministry of Health (MOH), Healthcare Services Employees’ Union, public healthcare clusters, community care partners and private healthcare providers, also proposed having effective reporting and escalation protocols, and a support structure for healthcare workers to report abuse and harassment.

Set up in April 2022, it engaged more than 3,000 healthcare workers and over 1,500 members of the public through surveys and focus group discussions conducted in the second half of 2022. It found that the more common types of abuse are verbal abuse, including discriminatory or demeaning remarks, and threats, including of taking legal action.

It found that more than two in three healthcare workers had witnessed or experienced abuse or harassment in the past year. About a third of all healthcare workers witnessed or experienced abuse at least once a week.

Such abuse is on the rise.

Health Minister Ong Ye Kung, in a written parliamentary reply to MacPherson MP Tin Pei Ling in January 2022, said there were about 1,400 abuse and harassment cases reported by the end of November 2021. There were 1,300 cases in 2020, 1,200 cases in 2019 and 1,080 cases in 2018.

The abuse usually takes place under a range of circumstances, like when there are requests for frequent updates that are not met; when a patient needs the nurse to speak in a certain language; and when the patient treats healthcare workers as personal attendants, expecting them to do tasks outside their scope of work or to give preferential treatment.

It is usually the front-line healthcare workers such as pharmacists, patient service associates and nurses who are more likely to experience abuse and harassment, the study found.

For instance, more than half (55 per cent) of pharmacists witnessed or experienced abuse or harassment at least once a week, and the reason is that they are often the last service provider for patients or their families before the patients are discharged.

Speaking at the Health Ministry-National Healthcare Group (MOH-NHG) Staff Engagement Session on Friday, Mr Ong said there is a need to have a clear definition of the word “abuse”.

“The Tripartite Workgroup has therefore defined abuse as any inappropriate words or behaviour that makes a healthcare worker feel distressed, threatened, harassed or discriminated against, even if the perpetrator said he did not intend to do so,” he said. 

One worrying trend is that healthcare workers have normalised the abuse and harassment, and have grown to accept them as part and parcel of the job.

“Many healthcare workers have grown accustomed to abuse as part and parcel of their work. I don’t think it is healthy,” Mr Ong said.

“Most of our healthcare staff remain professional, empathetic and compassionate towards patients, even in challenging situations. While sharing their experiences of abuse, they expressed understanding, saying that the patients were going through a lot of stress and uncertainty.”

Prevent and promote

There is a group of patients who cannot control themselves. These are people with diminished mental capacity or suffering from conditions such as dementia.

To prevent abuse in such cases, MOH will continue to equip healthcare staff with the skills to interact and manage escalating situations with such patients, said Mr Ong.

He cited the example of Humanitude, a care technique used at Khoo Teck Puat Hospital, where healthcare workers are trained to focus on aspects like gaze, speech and touch.

“We want to help patients and families understand the role of a healthcare worker, and that healthcare workers cannot be expected to do everything, everywhere, all at once,” he said.

To promote positive relationships between patients and healthcare workers, a public education campaign will be launched in the later half of 2023 “to align expectations and promote respect for healthcare workers”, Mr Ong added.

Public healthcare clusters SingHealth, National Healthcare Group and National University Health System said in a joint statement that they welcomed the findings and strongly supported the workgroup’s recommendations.

“While there are currently protocols in place across our institutions to support our staff, the standardised policy will strengthen staff protection by reinforcing the channels available for reporting and escalation, as well as increasing awareness of the consequences of such undesirable behaviour when it happens,” they said.

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