Staff in A&E are among those most likely to see violent patients

BBC News Online talks to one doctor about his experiences.

Dr Graham Hey Smith is a junior doctor. Earlier this year, he spent six months of his training in the A&E department of a busy hospital in north London.

By the end of his six month stay, he had been attacked six times. Patients had spat at him, sworn at him, tried to punch him and thrown a computer at him.

I have been lucky. Nobody tried to pull a knife on me or try to shoot me

"I think my experience is relatively typical," he says. "It is not all that unusual.

"In some senses, I have been lucky. Nobody tried to pull a knife on me or try to shoot me."

According to the BMA survey, doctors working in A&E are most likely to report that violence has become a problem at work.

"It goes with the job," says the 33-year-old trainee.

"I was working in an area where there is a lot of violent crime.

"A&E departments are also quite stressful parts of the hospital.

"Patients are hurt and are forced to wait hours to be seen. That can make many people violent.

"Sometimes people you would least expect to turn violent do so sitting in A&E. They are stressful places.

"On one afternoon, the A&E was taken over by two teenage girls, who you would normally expect to behave quite reasonably, swinging and throwing chairs at each other.

"In the end, one of our staff nurses had to wade in to stop them."

Medical problems

Nevertheless, many of the patients who are violent in A&E have underlying medical problems that may cause them to act in that way.

For instance, some have serious mental health problems, others are drug addicts and others may simply be acting out of character because of their illness.

"I have had elderly women who look harmless, spit and scream at me.

I have had elderly women who look harmless, spit and scream at me.

"The next day they would be perfectly pleasant. Their condition caused them to act in that way.

"That is really one of the basic problems. We have a duty to examine and treat every patient who comes through the door.

"It is not always possible to separate the bad from the mad. We have to examine them to see if their condition is causing them to act that way."

The nature of the job means that doctors really do not know who or what is around the corner.

They cannot predict if the next patient they call will be polite or murderous.

"There is an element of stress in it," says Dr Hey Smith.

"In the dog hours, between 2am and 8am, there was often just two casualty doctors on duty. Sometimes I was the only male doctor. It was stressful."

Poor security

In addition, many A&E departments have little security.

"There were security guards at the hospital I was working at," says Dr Hey Smith.

"But they were for the whole hospital so they would disappear if something was happening elsewhere.

"We could call the police and they were usually very good at turning up but you would have to wait 15 minutes."

In the end, many doctors have to rely on their powers of persuasion to calm potentially violent patients.

"You have to rely on you native wit and try to talk things down. Sometimes it works, sometimes it doesn't.

"In some senses, nurses get it worse than doctors because they see the patient first. They decide who should be seen first.

"One of the nurses working at the A&E department was a big strong guy. He ended up being off work for two weeks after being violently assaulted.