Violence

Suppose you're going for dinner and the waitress forgets to place your order, keeping you hungry at the restaurant for thirty minutes without a good reason. What would you do? Never shall I forget the last time when the waitress tried to hide the mistake and asked me to tell her my order again "so that she could trace the dishes for me." Seizing on her mistake and her "courageous move" to deny and hide it, I rose to my feet and taught her a good lesson.

"Take the response of the waitress to the scenario of a doctor," I told my medical students yesterday, "and you will see the point of open disclosure after our making a mistake."

Whilst eschewing the hackneyed moral responsibility of beneficence (meaning "to do good"), I thought about the medical doctor scenario played out in a different setting such as restaurant or departmental store customer encounter. Yes, you might rightly scratch your heads and wonder about similarity of health care service and other customer service. But trust me, they are alike in an intriguing way, but differ under certain circumstances.

This leads me to my recent encounter with a patient who approached my secretary with hostility, "I want to see my doctor NOW. Don't ask me why, you stupid bitch, it's urgent but none of your business."

I phoned up the police.

If this scenario is played out in a different setting, say, when a customer confronts a shop assistant with demands to see her manager, the decision might well have been to calm the situation, hear the customer out under the "customer knows best" mantra. Why, then, is this so different in the health care setting?

Most of us – certainly I include myself – have a long way to go before we will accept that "our patients know best." And, even if you talk to a medical ethicist, he or she will not accept infinite tolerance to patients who are abusive or violent. Although you might argue that health care workers' primary concern is to act in the best interests of their patients, it is equally important to think about the welfare of our staff, and clearly that of a wider patient group instead of one single aggressive patient. It would seem only common sense to put aside the moral responsibility to a violent patient whenever the medical staff is put at risk by that patient's aggressive or demanding behaviour. This we know best.