Academic journal article Australian Health Review

Occupational Violence in General Practice: A Whole-of-Practice Problem. Results of a Cross-Sectional Study

Academic journal article Australian Health Review

Occupational Violence in General Practice: A Whole-of-Practice Problem. Results of a Cross-Sectional Study

Article excerpt


Occupational violence is defined as 'Incidents where persons are abused, threatened or assaulted in circumstances related to their work, involving an explicit or implicit challenge to their safety, well being or health'.1

Although occupational violence occurs in a broad range of occupational settings, health care workers (along with other occupations such as juvenile detention workers and taxi drivers) are at relatively high risk.2 Health care professionals, including general practitioners (GPs), are at risk of violence in their everyday working lives.3,4 In the UK, violence is more prevalent among GPs than among specialist doctors.5 A cross-sectional study performed in urban areas of the same Australian state as the study reported here found that 64% of GPs had experienced violence at work during the previous 12 months.6 'Low-level violence' (property damage or theft, threats and slander)6 was most prevalent, and there were lesser, though still worrying, levels of 'high level' violence (stalking, physical abuse, sexual harassment, sexual abuse)6 identified. Comparable prevalence of violence has been documented in rural Australian GPs (73% reported having experienced violence during their careers)7 and in Victorian GPs (57% experiencing violence in the previous 12 months).8 Consequently, violence directed towards GPs and their staff has been recognised as a significant occupational health issue - especially in the UK9 and in Australia where the 2006 murder of a Melbourne GP in her consulting room has challenged the profession to engage with this complex problem.10

The situation regarding non-GP staff is less clear. Previous research has suggested that violence against receptionists is more common in general practice than in hospital settings5 and that receptionists may be exposed mainly to 'low-level violence' - especially verbal abuse - when compared with GPs.11,12 But these latter findings are based on the reports of GPs, not on reports of the receptionists themselves. Three studies have specifically examined occupational violence from the perspective of the receptionists. These studies, conducted in the Republic of Ireland13 and the UK14,15 have demonstrated prevalence of violence comparable to that found in GPs - a career prevalence of violence of 62% in Irish receptionists13 and a 68% 12-month prevalence in receptionists in England.14 By far the most prevalent form of violence in these studies was verbal abuse13,14 (as it has been in studies of GP violence from the UK5,16-18 and Australia6-8). Despite the large literature around occupational violence affecting nurses we could find no studies of occupational violence and general practice nurses or allied health staff in general practices.

The study reported here is the first attempt to compare directly the experiences of occupational violence of GPs and non-GP staff. Based on the results of the qualitative phase of this project,19 we hypothesised that a greater proportion of non-GP staff, compared with GPs, would have experienced violence, would be apprehensive about violence, would feel that violence was a problem in general practice, and would feel that they did not have control over their safety at work.


The setting of the study was an Australian regional Network of Research General Practices (NRGP). The NRGP comprises 14 practices of varying size, socioeconomic status of practice population and rurality: Rural Remote and Metropolitan Areas (RRMA)20 1-5 are represented. RRMA 1 and 2 signify metropolitan areas and 3-5 signify rural areas. There are no remote area practices (RRMA 6 and 7) in the NRGP.

Following a qualitative study of receptionists, practice management staff and practice nurses in the NRGP,19 a 31-item questionnaire was constructed based on that used in a previous study of GPs6 and incorporating further items informed by the findings of the qualitative study.

Information packages containing the questionnaire and inviting participation in the study were distributed to GPs and to allied health, nursing, receptionist and practice-management staff of the 14 constituent practices of the NRGP in April 2008. …

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