Journal of General Internal MedicineVolume 12, Issue 2 p. 137-137 Free Access Letters to the Editor First published: 28 February 2002 https://doi.org/10.1046/j.1525-1497.1997.07104.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Discrimination and Abuse in Internal Medicine Residency To the Editor: —We read with great interest the recent article by vanIneveld et al. on discrimination and abuse in internal medicine residency.1 Having studied the problem of violence against physicians in an American hospital,2 we were anxious to learn more about the Canadian experience with physical abuse of physicians. The authors report that “approximately 40% of all housestaff had experienced a physical assault at some point during their internal medicine training.” We would be interested in knowing whether “assault” was defined in their questionnaire. While in a legal sense assault denotes “a . . . threat of force sufficient to arouse a well-founded apprehension of battery,”3 colloquially assault may connote battery (defined as “rude and inordinate contact with the person of another”3). We suspect that the authors were, in fact, actually writing about battery, since they refer specifically to “physical assault” (italics added). If indeed vanIneveld et al. were studying battery, then their reported results differ substantially from ours. In our study, while 41% of responding physicians reported being assaulted in a legal sense, only 16% reported being battered. We wonder whether the difference in results stems from a true difference in the prevalence of violence against physicians or from linguistic confusion.—Frederick Paola, MD, JD,andTariq K. Malik, MD, MPH,University of South Florida College of Medicine, Tampa, and Mount Sinai School of Medicine, New York, NY. REFERENCES In reply: —We thank Drs. Paola and Malik for drawing our attention to their comprehensive survey of violence against physicians in which they specified definitions of assault and battery and provided descriptive and circumstantial detail of the abusive events. We propose several potential explanations for the results generated by our two studies. First, respondents differed demographically (we surveyed a national sample of internal medicine residents rather than a combination of housestaff and attendings). Second, respondents may have had different interpretations of abusive episodes (Paola and colleagues provided precise definitions whereas we relied on experiential reporting without prompts). Third, respondents may have experienced similar events but have different thresholds for labeling and tolerating them. Fourth, respondents in the two studies may have interacted differently with patients, creating different patient-clinician dynamics. Other hypotheses include the effect of different perpetrators (we included supervisors, physician colleagues, patients and their families, whereas Paola et al. considered only patients and family members). Our housestaff may have been exposed to more high-risk encounters involving patients with dementia, delirium, psychiatric illness, and drug influences. The settings, whether supervised or isolated, may also have differed. On balance, we believe that most studies endorse these problems as too prevalent. We hope that others will continue to view understanding the culture of our workplace as a research priority, and promoting humanism as a personal and professional responsibility.—Deborah J. Cook, MD,andSheri-Lynn Kane, MD,McMaster University, Hamilton, Ontario, Canada. References 1 VanIneveld CHM, Cook DJ, Kane S-LC, King D. Discrimination and abuse in internal medicine residency. J Gen Intern Med. 1996 ; 11: 401 – 5. 2 Paola FA, Malik TK, Qureshi A. Violence against physicians. J Gen Intern Med. 1994 ; 9: 503 – 6. 3 Morris C, Morris CR. Morris on Torts, 2nd Ed. Mineola, NY: Foundation Press, 1980;21–9. Volume12, Issue2February 1997Pages 137-137 ReferencesRelatedInformation
Search from 250 M+ research papersSearch from 250 M+ research papers
Dec 1, 2001
Dorothy P Rice 
Open Access