"I was in my office with people waiting and suddenly a gentleman got up and said 'no one else passes here until my mother comes in. She pushed me, she insulted me and when I told her to call the police, she told me' I am the police! "I filed a complaint and sentenced the retired agent to one year and one month in prison". The episode experienced by a doctor who asks for anonymity four years ago in a health center in Badajoz is one of the outbreaks of violence that health professionals suffer every year. There are thousands, from less to more intense, from insults to beatings, but they occur more frequently or at least more are reported. Last year there were 6,384 "violent situations", of which 954 were physical aggressions, 70% to women, according to the preliminary data of the first Statistical Report of Assaults in the Health Area, collected by the group of analysis and study of the aggressions to the professionals of the National Health System that the Ministry of Health created in 2017 at the request of several groups and Autonomous Communities.
This violence occurs above all about women (70%); it focuses on consultations (28%), offices for requesting appointments (15%) and emergencies (13%); the average age of the aggressed professionals is between 35 and 55 years old and 70% of the aggressors are men, especially patients (60%). "In lIn the remaining cases, those responsible for the aggression are family members or other companions", according to the CSIF union, which advances the data of this first record of aggressions at a national level, which in its majority "they occur because the patient is dissatisfied with the care received (in 50% of cases), although they are also due to administrative management or other reasons unrelated to health care. "These first" official "figures point to an increase in the aggressions: according to the statistical data of aggressions to health services published by the Ministry of the Interior, 2018 closed with a total of 298 incidents that caused 322 victims, of which 54.9% were women.
However, as regards exclusively the medical community, the data of the National Observatory of Attacks of the Medical Association reflect a decline: last year, 490 professionals suffered an aggression, 4.8% less than in 2017. They occurred especially in the public sector, 85%; and it is in hospitals and health centers where the majority of attacks occur - 23% and 53% respectively-, which usually come from patients (70%, while the rest are companions) and consist of threats (51%), insults (35%) and, to a lesser extent, injuries (14%).
The WTO and the SATSE nursing union blame the attacks on the cuts, which have multiplied the waiting lists and deteriorated the management of emergencies and primary care, a focus of tensions where patients are irritated to the minimum and blame the professionals of the system cracks.
"The lack of professionals in primary care has people tense. If the patient, instead of waiting for seven hours, expects one, his attitude and aggressiveness will be less compared to the doctor, "says Carlos Camacho, responsible for prevention of the Andalusian Union of Doctors in Malaga, a province that usually leads the indicators of attacks in this community. "Patients are increasingly upset, you just have to see the street demonstrations for primary care and the deficit of doctors with the mass consultation", José José Becerra, coordinator of the WTO National Observatory. "The cuts and prolonged waiting times sharpen the tension and generate frustration," concludes Verónica Díaz, of the SATSE nursing union in the Community of Madrid.
The tip of the iceberg
Seven years ago the average was 6,083 aggressions per year throughout the health system, 16 per day according to the records of the Ministry of Health between 2008 and 2012. And professionals warn that these numbers are only the tip of the iceberg because most of attacks are not reported. The Ministry itself set a very low percentage in 2014: 10.95%, since verbal aggressions are our daily bread in numerous consultations. The panorama of professionals seems to change, but little by little. "Before, the doctor resigned himself and thought that the insult entered the payroll, now no longer, "says Héctor A. Galache, lawyer of the Official College of Physicians of Badajoz with 11 years of experience in defending these cases.
As possible solutions, the WTO admits that regardless of whether students receive more health education, it is necessary to reinforce the didactic and left hand of doctors in dealing with patients. "We must train doctors in assertiveness, detection of aggressive patients, resolution of conflictive situations and empathy. Above all, in the target population: young doctors who leave the hospital with little treatment with the patient. We all do not have the same treatment, some of us are not Guardiola, we are more Mourinho ", acknowledges Becerra.
How do patients lose their roles until they attack doctors, nurses, assistants or warders? "They are banal issues that people tolerate badly. Behind each case there is a 'no' or a 'then' in a crushing percentage, "says Galache. On the bench opposite, the lawyer Javier Saldaña censures that these attacks "are overrated." "You can be ordered up to two years in jail in cases without physical aggression, not a single scratch, and not a day's sick leave from the doctor. You have to put yourself in the patient's place when, for example, there has been a near death ", exemplifies the lawyer. Since 2015 attacking a health professional is more expensive, since the crime of attack is against an authority and can carry up to four years in jail. But that armoring has not stopped the attacks.
Until last summer many professionals avoided pursuing the legal route because their personal postal address should be recorded in the complaint, which could lead to assaults or harassment continued by the patient reported outside the health center. Today, doctors and nurses have become witnesses and police bodies or associations appear as accusers in the proceedings.
Last June in Camarena (Toledo) a patient attacked a doctor with an iron bar and eight months later he remains in critical condition. It may be the second fatality from the doctor who died in Murcia a decade ago. The way to go is very vast, health professionals agree.
One of the innovations to reduce the impact of the aggressions in the health is Alertcops, an application launched in 2015 by the Ministry of the Interior but that at the end of the year hopes to incorporate a panic button for the toilets. "The professional who sees himself in danger will press his mobile and generate an audio of 10 seconds. The police operator will listen to the recording without having to talk about the toilet ", explains the Commissioner Javier Galán, health police interlocutor who coordinates 54 agents spread across the country and who liaise with health centers to try to mitigate the rise in violence .
In the next few months a pilot test will be carried out in a province and then the system will be extended to the rest of the country. The police in the cities and the Civil Guard in rural areas have since 2017 the task of establishing protocols with hospitals and health centers to facilitate complaints from doctors, nurses, assistants and warders, and establish guidelines to reduce violent behavior.
The aggressions multiply on Tuesdays and Wednesdays, between 10.00 and 12.00, with a spike at 17.00, according to the data collected by the police during the last year. "In November and December the criminal activity goes down, we still do not know why," says Galán, whose agents have held 1,300 meetings in 2018 to draw conclusions that help to x-ray this violence, waiting for the government to create the unifying body. the river of scattered information.
The first step is the geolocation of the 3,000 health centers and 799 hospitals that exist in the country, according to the Ministry of Health, data collected both by the Police and the Civil Guard.