Joint session focuses on clinician safety
By Stacey Butterfield
Keeping internal medicine physicians safe is a priority on both sides of the Atlantic, meeting attendees learned during a Thursday morning talk. The session "Protect Healthcare Professionals to Deliver Optimal Patient Care" was a joint presentation by leaders of ACP and the European Federation of Internal Medicine (EFIM).
EFIM President Ricardo Gómez Huelgas, MD, PhD, FACP, led off by reviewing the numerous threats to health care professionals' safety. "Medicine could be considered a high-risk profession," he said.
Dr. Gómez Huelgas focused in on three concerns in particular: exposure to infectious diseases, work-related stress and burnout, and workplace violence. There are clear strategies to combat the first problem, he noted, reviewing World Health Organization guidelines for preventing occupational infections.
The second challenge is more expansive. "Stress and burnout increase the risk not only for professionals, but also for patients, because they increase the risk of medical errors, and also reduce the quality of care and raise costs of the health care system," said Dr. Gómez Huelgas.
A major concern is the rates of this problem among young physicians, he noted, citing a survey EFIM conducted in 2022 to 2023. "Almost two-thirds of our young internists feel stressed usually or always about their work," Dr. Gómez Huelgas reported. "Over 40% of our young people feel anxious at work."
The third problem, violence, has also become worrisomely common across the world, he said, citing a World Health Organization estimate that up to 38% of health care workers experience violence at work during their careers. "That was in prepandemic times," he noted. As with burnout, the pandemic has worsened the situation.
"This problem is a social problem with big repercussions," Dr. Gómez Huelgas said, translating a headline from his hometown newspaper for attendees: "Assaults on doctors have doubled in the last year."
Following his summary of problems shared "across the pond," ACP Board of Regents Chair Eileen Barrett, MD, MPH, MACP, delved into potential responses. "There are some solutions that are out there," she said.
Dr. Barrett's first set of strategies came from Europe, in a paper reporting on an ED in an Italian hospital. "They identified that there were some potentially problematic situations," she said. "It's good to know a little bit more about what are the drivers." Specifically, the report found that while verbal violence usually comes from lucid patients, physical violence is associated with factors such as dementia, schizophrenia, and intoxication, among others.
Data like these can be used to develop staff trainings on violence prevention, Dr. Barrett suggested. "We can incentivize, but also reward interactive, professional training," she said, "not performative-type, check-the-box work, but actually the real work that changes things."
The Occupational Safety and Health Administration also has guidance that can be applied to make medical workplaces safer, ranging from well-known strategies like metal detectors to less obvious ones, Dr. Barrett said. "Tactical things that you don't think of it until someone says it to you … chairs will be bolted down in some places or the IV pole in the ER will be actually attached to the bed so that someone can't pick it up."
Another strategy to improve safety is advocacy. Dr. Barrett directed attendees to ACP's toolkit on addressing violence against physicians and health care workers. "It has these examples of these letters that you can just cut and paste into an email" to send to your legislators and advocate for greater protections for clinicians, she said.
Burnout also has some legislative fixes, she noted, highlighting recent successful efforts to remove questions about mental health treatment from physician license applications. "If you have the bandwidth to be a part of that change, we can just make it easier for people to get support," she said.
As an example of how to encourage clinicians even more strongly to seek psychological support, she cited a trial that automatically scheduled mental health care appointments for interns. "What percentage of interns kept the appointments?" she asked the audience, getting responses from zero to 75%. The correct answer was 91%. "People want this care," Dr. Barrett said.
For more mental health resources, she directed her listeners to the I.M. Emotional Support hub.
To close out the session, Dr. Gómez Huelgas, Dr. Barrett, and ACP President Omar T. Atiq, MD, MACP, who served as moderator of the session, took questions and reflections from the audience. "Let us know what you think," Dr. Atiq said. "This is how we get to where we want to go." ■