Prevalence of Verbal Abuse Among Doctors in Tertiary Care Hospital

ABSTRACT Introduction: Verbal abuse is the act of forcefully criticizing, insulting or denouncing another person. Verbal abuse can be devastating to doctors and may cause long lasting emotional and psychological damage. This study aims to find the prevalence of verbal abuse among doctors in tertiary care hospital. Methods: This descriptive cross-sectional study was conducted among doctors in a tertiary care hospitals, Chitwan from January to July, 2019 after taking ethical approval. Convenience sampling was done. Self administered questionnaire was distributed and data was collected. Point estimate at 95% CI was done for binary data along with frequency and proportion. Data were entered and calculations were done in Microsoft excel. Results: Verbal abuse was found among 80 (33.3%) respondents at 95% Confidence Interval (27.51-39.09%) and most 51 (63.8%) of perpetrators were relatives of the patients. Most 38 (47.5%) of the doctors were often worried in workplace. Incident of the verbal abuse was more 35 (43.6%) in morning and least 14 (17.4%) in night. Most 22 (27.5%) of the doctors did not take any action for incident although most 42 (52.5 %) of the doctors were encouraged by colleagues to take action. Conclusions: Prevalence of verbral abuse among the doctors were found out to be similar as the previous studies conducted in similar settings. This study has shown that doctors were frequently verbal abused by patient's relatives and were abused mostly in morning shift and were often worried in workplace.


INTRODUCTION
Verbal abuse has been known as a significant issue Verbal abuse against doctors can affect the work performance and productivity in hospital. 1 The prevalence of workplace violence in the last 12 months was found to be 63.41%, whereas the lifetime prevalence was found to be 78.05%. 2 Violence against doctors is increasing in Nepal and will continue to surge until the effective measures to improve healthcare in our country. 3 However, this issue is under researched and little evidence exists so the researcher interest to do study on this research problem.
Maximum (87.3%) of the reported cases were of verbal violence while 8.6% of the cases were of physical violence. 4 Higher rates of burnout, low self-esteem and self-destructive aggression are main symptoms in health care professions. 5 The present study aims to find the prevalence of verbal abuse among doctors in a tertiary care hospital.

METHODS
This descriptive cross-sectional study was conducted in two tertiary care hospitals: Bharatpur hospital and Chitwan Medical College and Teaching Hospital, over a period of January to July 2019. Ethical approval was taken from Ethical Review Board of National Health Research Council and also from Chitwan Medical College and Teaching Hospital and Bharatpur Hospital.
During the study 276 questionnaires were distributed, 255 were returned and 15 were discarded due to incomplete information for the study.
Convenience sampling was done and sample size was calculated using the formula: where, n= required sample size p= prevalence the burden of verbal abuse among doctors (30%, educated guess) q= 1-p e= margin of error, 6% Z= 1.96 at 95 % CI The total sample size calculated was 224 and after adding non-response rate as 7%, the total sample size taken was 240. The data was collected in a selfadministered questionnaire and analyzed by Statistical Package for Social Sciences 20 version. Point estimate at 95% CI was done for binary data along with frequency and proportion.

RESULTS
Out of 240 study participants, verbal abuse was found in 80 (33.3%) participants at 95 % CI (27.51-39.09) ( Table 1). Thirty eight (47.5%) were found to be often worried and 5 (6.3%) were never worried. Out of total, 42 (52.5%) respondents were encouraged by colleague to take actions for the verbal abuse but 22 (27.5%) respondents did not take any actions (Table 1). Majority 170 (70.8%) of the respondents were verbally abused for 6-12 months and 1 (0.4%) of the respondents were verbally abused for 37-48 months ( Table 2). Out of total abused, 35 (43.6%) faced verbral abuse on morning time followed by evening and night.    7 Our study has shown that most of perpetrators 51 (63.8%) were relatives of the patients. Study in India also showed the similar finding i.e. patients and their relatives are the most common perpetrators. 6 Other study also reported that in most of the cases of violence, the perpetrators were either patients or their relatives. Either patients or their attendants were the main perpetrators of violence which was 84.5%. 4 Our study showed that the incidence of the verbal abuse was more 35 (43.6%) in morning and least 14 (17.4%) in night. Similar finding was by a study which showed that maximum events of the verbal abuse took place in morning than evening and least night shifts. 4 Another study found that verbal abuse incidence occurred especially in evening and night time which is contradict of this study. 7 In this study, we found out that most 38 (47.5%) of the respondents were often worried in workplace. One of the study reported that the increasing incidences of violence against doctors in their workplaces is the important reason for stress among these healthcare workers. Maximum (87.3%) of the reported cases were of verbal violence. 4 Other study also showed that higher rates of burnout, low self-esteem and self-destructive aggression are among the violence in the health care system. 5 A study concluded that verbal abuse obviously impact on the effectiveness of health systems, especially in developing countries which should minimize and should prevented as much as possible. 6 Other study had suggested that organizations must adopt zero-tolerance policies and training and in-service education should be given to prevent incidence of the verbal abuse. 7 CONCLUSIONS Prevalence of verbral abuse among the doctors were found out to be similar as the previous studies conducted in similar settings. This study has shown that doctors were frequently verbal abused by patient's relatives and were abused mostly in morning shift and were often worried in workplace. Furthermore, for the nation's parlous state of healthcare to improve, much emphasis should be placed on ensuring to prevent abuse in the workplace. So necessary that certain strategies are plan to guarantee the safety of health care providers in every health care institutions in Nepal.