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“Bullying” is sometimes defined as “unwarranted treatment” and it can take many forms. There have been numerous discussions about senior doctors bullying juniors, and of other NHS staff bullying doctors.
It might feel like breaking a taboo, but have you ever felt bullied by a patient?
Can anyone share a story about bullying from a patient they have experienced, witnessed or heard about? What types of doctors or students might this affect most? What might have made the patient act in that way?
The GMC’s only guidance around this is on page 8 of their “Guide for Patients” (see http://www.gmc-uk.org/guidance/patients.asp), “You should also be polite and show respect to your doctors.” Is this enough? Do junior doctors need more guidance and support in this area?
You can post anonymously in this section - let us have your thoughts.
I am a hospital doctor and graduated in 2001. I am now looking for a consultant post and work as a fellow in my chosen discipline. I have numerous examples of patient bullying:
1. For the first time in my career I was forced to see a patient who had complained about me AFTER the complaint had been sent to me by PALS, clearly stating that the patient was refusing to see me because I lacked "people skills". I came out of theatre, late unfortunately, went straight down to start my afternoon clinic and two senior nurses were waiting for me. They said the patient still wanted to see me and I, foolishly, agreed (when I hadn't eaten all day). This patient was wheeled in and then proceeded to try and humiliate me in front of the member of the nursing staff who had stayed in to "monitor" the consultation. Every time I stated my view the patient would say to the nurse "I told you so...". I felt demeaned and humiliated by the whole experience and will never accede to a request like that again. The patient and her husband now come to the clinic and stare at me across the room. Fortunately, because of the complaint, I have refused to ever see this patient again (I'll resign if I'm forced to).
2.I was publicly abused with foul language and a loud voice for 45 minutes by the wife of a patient while an SHO in A and E 12 years ago. Instead of ejecting the patient from the department I was forced to continue working while this person was served by a staff grade in the next cubicle and continued to abuse me throughout. The wife then complained in writing about me. She was forced to apologise when witnesses confirmed that she had sworn at me for 45 minutes in front of members of the public. The wife turned out to be a member of staff at the hospital .
3. As an A and E SHO in my fourth 6-month post as a doctor, I told a patient's partner I could not carry out a scan on his girlfriend's six week foetus because it would not show up on the scan. The patient's boyfriend threatened to "rub me out" because of my refusal - a death threat. I ignored it but I still remember it 10 years later. Fortunately the threat has not ever been carried out.
4. As a medical student I saw a GP refuse to give a patient antibiotics. I was shocked when the patient shouted at the GP and said :"I know my chest, I know my chest!". She then walked out slamming the door. I am proud to say that the GP stood his ground and did not prescribe the antibiotics. I am not surprised so many doctors do - who can put up with that on a daily basis?
5. In one of my first junior jobs in my specialty, a patient turned up 45 minutes late for an appointment at a London hospital. As I had to go on to my next clinic, and the patient turned up during this, I instructed that the appointment be made at another time. When I then saw this patient, she rebuked me for having rescheduled the appointment. It was for a trivial thing - a corneal abrasion. I instructed the patient not to patch the eye and she ignored my advice. By patching the eye she managed to activate a longstanding underlying fourth nerve palsy giving herself double vision. Then she demanded to see the consultant because she didn't want to see me. Then she made a written complaint about me.
6. I am an ethnic minority female. Again, in a and e, a patient refused to see me because I of my ethnicity. My colleagues rallied round and ejected the patient from the department with the words"If you won't see this doctor, you will not see any doctor in this department". Many patients complain about me because they don't want to be served by a black or ethnic minority person although they will not admit it but in fact it is often very obvious. Serving such a patient is demeaning, degrading and difficult. Some hospital's accede to this request for white doctors only and one hospital kept it up for a whole year! (See Moghal's piece in a recent BMJ)
7. a junior colleague in her first post-foundation job came to me close to tears with her first complaint. She was from Pakistan and wore a Hijab. The complaint referred to being able to smell her dinner of the previous evening during the consultation and other racist comments. There were comments about attitude which were contrived and there were some other examples of disgusting racism. Unbelievably, this patient was allowed to continue to come to the department with no action taken upon them at all. I was merely left to comfort this trainee and tell her my own motto:"Never stop being kind".
I could go on and on and on. I could fill this box with the 18 years of really appalling behaviour I have seen from patients as a medical student and as a doctor, particularly to ethnic minority and women doctors. And I was a mature entrant to medicine so I know exactly what bad behaviour looks like and, truth to tell, I have not encountered it on this scale in any of the other jobs I did before entering medical school. The subtle undermining ("isn't your English good" when I'm born and bred in the UK, or ignoring me in favour of my white male ST1 who knows nothing!), the nasty looks, the insulting comments in complaints attributing attitudes and behaviours to me when these people don't know me from Adam. I won't even get started on the behaviour of some doctors as patients and the so called "professional" misbehaviour I have encountered. However I don't understand why patients are being allowed to get away with it. Thanks to mid Staffs, patients are now well versed at running to PALS in an attempt to get their way. The nursing staff encourage them to do this ("here's a leaflet - go to PALS") and then do nothing practical to try and help the patient. Staff have to suppress their personalities and be some sort of automaton - unable to smile, joke or even sing! This working environment is oppressive but it is even worse if you are junior and don't have the support of your seniors (see example 6 above - I would never have survived that without the solidarity of colleagues.) From the Lancelot Spratt days when the consultants were gods, it has now gone the other way and the patients are marauding and something urgently needs to be done about it. Patient centred shouldn't mean patient bullied but, I'm afraid, it frequently does (and patients know it!)
Yes, in the private sector, by a patient who told me he was extremely famous, in fact more famous than someone else in his field whom I had heard of and that he would cause trouble for me if I didn't treat all of his requests to nursing staff to see the doctor as emergencies and drop everything else to run to him.
In reply to Anonymous:
I'm a 36 year old GP. I'm asian in origin but born in the UK. I'm 6'2 and rather handsome.
I've been thinking back over my 13 years a doctor. I can remember only one time a patient bullied me-a racist BNP thug type who was in a wheelchair with an injured back as I wheeled him to a cubicle in A&E. One of the surgical reg's was writing notes and promplty took control of the wheelchair and wheeled him out into the waiting area again :D
Women doctors have it MUCH worse than men do, and minority ethnic women docs the worst. Good looking male and female docs get less hassle.
Your looks is not the point here is it? I'm afraid that
accepting a less attractive , female , minority ethnic
enduring bullying more does not address the
problem and your comments almost accepts
it as it is because maybe it's not happening to
you. I'm a pretty black woman and I have had complement
all my working carrier, however, whenever I have
seen bullying by whoever, patients included it has
been my instinct to step in. Maybe those who aren't
bullies must insist on high standards and help
those who are. I must add, very often the person doing
the abusing or bullying tends to have an inferiority
complex and it's obvious this is how they give
themselves a boost- often to their own disadvantage.
If only they will learn to deal with their own
problems better, they might just end up decent.
About a year ago, my consultant and i were one day told by two ladies on a medical ward that they don't wish to be treated by us, because we were both of different ethnic origin. The nurses handled this by telling the patients that we were actually the only doctors available on the ward, and the ladies got treated and discharged about a week later.
All the time!
"Cheeky specky bastard" memorable
But the worst was when they called me a "pensioner" just after I got the letter saying I was not going to gety state pension in 3 years but 10!
They try to get you to precribe strong analgesics benzos sleeping tablets and of course lyrica
It is all one way in the nhs. We are here to serve and the GMC is unbelievable
I have been qualified since 1991. Until recently I would have said I hadn't been bullied by patients as I am outspoken and can stand my ground however a new phenomenon has come to my attention- the internet rating sites. I have in the space of 6 months had 3 people post angry at my perceived lack of care, my failure to give diagnoses they want, the list goes on. I unfortunately have a unique name so know it is about me. One posted vitriolic comments about me and has since gone on to make a formal complaint, I feel they have lost that right due to using the court of public opinion but managers just bend over backwards taking a stance the patient is right. In one case a patient proceeded to make personal insulting comments about me and complained when I stood up for myself and said either she left the room or I would.
'Zero tolerance' appears to be a pie in the sky concept rarely enforced in my speciality
I am an elderly medicine consultant and my patients are never the issue. However there is a growing minority but very time consuming number of relatives that will verbally bully, and threaten to formally complain including the CQC if things do not go their way immediately. Usually they are failing to recognise their very elderly relative is in terminal decline and they are frightened or that they are feeling guilty because they live too far away to be of practical help or have other family/work commitments. The trouble is this behaviour is usually to the detriment of the actual patient as they get over investigated and moved to the wrong environment for them. I have seen patients become acutely depressed because of their relatives behaviour and start wanting to die. The effect on the nurses who take the brunt of this is dreadful and the time spent trying to help these families get back on track is a major burden and to the detriment of other patients clinical care.
Recently on telephone triage as a GP I didn't accede to a patient's view that she needed an urgent BP that day. She had already been given an appointment by reception for 3 days later. I was told I would be reported to CQC, and that the NHS was going to the dogs, as she couldn't get to see a GP when she wanted to. I think we need a few more journalists and politicians to tell the story from our viewpoint. I worked 11 hours without any break that day. I managed to shovel in a sandwich, whilst keeping my afternnons patients waiting for 10 mins. The second patient then complained I had kept her waiting. My thought was I'd be a better Dr with some food and drink inside me. I'm female. It might be relevant.
It is now routine for patients and their relatives to vent their anger on junior doctors - a process promoted by television doctors giving the impression that all doctors can cure everything, the Daily Hate Mail (all doctors are devils) and the scarcity of nurses.e
I too, see mostly old people and find it's their relatives I have trouble with. They often come to clinic with an agenda and aren't happy unless they leave with their pre-conceived plan. My worst example was of a sister who tried to dominate the consultation. She wouldn't let me talk to her brother, who was little slow, but perfectly capable of describing his symptoms. I asked to let me speak to her brother, but she said he knew nothing as he was handicapped. She eventually stormed out of the room, shouting and told all the other patients in the waiting room how bad I was. Her brother was clearly bullied by her too, saying that perhaps she ought to come back in to answer my questions. She insisted that she knew her rights, that she got to dictate what treatments he had and that I knew nothing. She shouted and pointed at me aggressively. On operation day she was worse. On both occasions I got palpitations and chest tightness.
I am not sure that a complaint about smelly clothes is racist. Working in London with some Asian colleagues I experienced this quite frequently. It is nothing to do with race, but poor personal hygiene.
Threats to kill me occur about once a month; threats to punch or kick more than once a week (actual violence usually avoided by dodging out of the way).
Psychiatric services are so habituated to this problem that aggressive patients are not moved to low or medium secure services unless there is police/court involvement.
Police are called at times when staff are physically injured, but often the police do not even bother to attend because they know it is a psychiatric hospital and that "the public" are not in danger. Staff aren't considered real people by the police and increasingly they are not seen as real people by anyone else either.
Family of my patients (who don't appear to have the excuse of having a psychotic illness) are also frequently bullying. I have had parents threaten to report me to the GMC unless I prescribe their son/daughter what they demand (often experimental drugs such as oxytocin for autism or ketamine for depression) as well as shouting and swearing at me and telling other staff, patients and visitors that I am evil/cruel/a bitch etc.
These behaviours are often dismissed by those who no longer have direct patient contact. We are told that we have to be understanding of the patients and their families who are distressed.
But these behaviours often aren't restricted to periods of time when the individual is distressed. I have had several families who have made continued campaigns to libel me both in letters to managers and online. Fortunately I keep meticulous notes and it has been possible to demonstrate that the families are lying. But the onus was on me to prove my innocence ('innocent until proven guilty' only applies to real people, not doctors). The family's lying letters are still in a file somewhere with my name on and online material has never been addressed either.
Some families who have shouted and sworn at me and nurses have been able to present themselves in a much more appropriate way when hospital managers and commissioners were present.
Some professional groups seem to be able to cherry pick their patients. Those that show the behaviours above are removed from the caseloads of clinical psychologists, OTs, etc. Doctors and nurses don't have that luxury.
Some of the examples other doctors have given have suggested that nurses have been complicit in encouraging spurious complaints. My experience in mental health settings, both inpatients and community, has been that nurses are frequently also the target of bullying by patients and their families. Where PALS leaflets are handed to patients, this has often been a tactic to prevent the situation from escalating to physical violence. Many times, families are happy to hurl abuse and shout their complaints in person, but when asked by a manager or other person to actually define what their complaint is about it becomes obvious that they are talking nonsense. I assume the same happens when patients phone the GMC; the vast majority of phone call complaints to GMC are dismissed before the point of investigation.
When a patient's father shouted that he would f***ing report me to the GMC if I didn't cure his daughter's autism with oxytocin, I nodded my head and said I would wait to hear from the GMC about it. Of, course they haven't contacted me. But it didn't stop the parents from sending several letters of complaint to everyone else they could think of. I was asked by a commissioner why I hadn't sorted out the parents' problems with family therapy. Just one of many examples of the unrealistic expectations of commissioners. He wanted us to spirit family therapy out of the ether; but would he fund it? No.
I have also experienced gender discrimination. One patient's father announced during a CPA that he didn't want his son to get lumbered with a female consultant. He didn't want him to have any female staff because he thought we wouldn't understand him, but he would grudgingly accept female nurses because "it's a woman's profession" (this was a snide comment directed at his son's male named nurse). The son's female social worker didn't raise any objections to this, but the father was told later by my (male) medical director that employers could not employ staff on the basis of gender, race, etc, but on ability. After that the father invented some other reasons for his son needing a different consultant. He got his way because of pressure from, guess who? Commissioners.
I have also experienced some racial discrimination. I am white and was told by a patient's mother that she wanted her daughter to have an African-Caribbean doctor because I wouldn't understand their issues (the family had lived in the UK for three generations so I assume they had seen health professionals of many races in that time). As a trainee at the time I was able to discuss this with an African-Caribbean nurse who worked in the team. She agreed to work jointly with me. After a few appointments the nurse reached the conclusion that there were no cultural issues cropping up (I didn't have the confidence to say that) and that she should let me continue working with the family on my own. The family then asked me again to have another member of staff. The only other staff that had time to see them was one other white person and one Asian. The mother expressed some racist comments about Asians under her breath. She didn't bring her daughter to any other appointments. When she was contacted by the team administrator subsequently to see if she was going to attend or be discharged she told the administrator that I had told her she could only have a white doctor because she was in England and if she didn't like white people she should go home. I was very glad to have had my nursing colleague work with me for a while with the family, as she was able to refute the mother's claims. Despite what the nurse told the team manager, he still felt he had to investigate any allegation of racism, and he asked the mother to put the complaint in writing. She didn't, and nothing else happened but I was left in limbo for several weeks waiting to find out if she was going to invent further lies about me.
All of the extensive examples above show that it has become 'normal' for health care professionals to be abused by patients & relatives. I also could give equally extensive examples. I feel this should be stopped as in most cases abuse like this would not be acceptable in any other setting. The zero tolerance policy of the NHS should finally be implemented. Is there anyone out there who knows who has got responsibility for this? We should be addressing these comments to that person and maybe give it a higher profile by giving it some publicity. It also has a real cost factor to it if one calculated the days lost due to illness caused by stress and distress. What are we going to do about it other than to complain amongst ourselves?
That`s the trouble with doctors. Too busy, too knackered and move on too fast. Do we risk our references and subsequent job chances or keep our heads down knowing we`ll be off to another/better job soon. We can`t club together, but surely that is what our union is for?