Table 3 Representative quotations

Types of violence

“Verbal, almost on a daily basis, especially when it gets busy. Recently an attender, because we didn’t have beds, was very frustrated. He started calling us words like ‘idiots, fools.’”

Experiences of violence

In regards to a recent patient who presented with abdominal pain and difficulty breathing who later went into septic shock, “They started shouting, ‘What have you done with our patient? How did she become hypotensive? Initially her BP was fine!’ And they were not able to understand… They were talking like, ‘You didn’t give her anything to drink so that’s why she went into shock!’ Two or three attendants were there and all of the were shouting and the situation escalated quite a bit.”

Causes of violence

“People shouting, demanding for fast disposition in spite of other patients. When you are attending some other serious patient, they don’t understand the fact that the other patient needs much more attention. They just want their part to be cleared off and to be sent home.”

Description of events

“One patient arrested, so my colleague immediately started CPR. But when the patient attender came inside, they thought we were beating him… The lady, I think the patient’s wife, she gave a slap to my colleagues… it took so long to convince them what actually happened.”

Consequences

“For the residents and physicians, it creates and unhealthy environment and a lack of trust.”

Responsibility

“It’s not only patient bystanders. If any violence is happening in the ED we can combat the violence by constantly counseling the patient attenders regarding the process what’s going on. Suppose a patient comes and we say ‘this lab takes 2-3 h, this is the cost.’ If we counsel everything from this point to point the violence part at least will calm down. See India is a developing country, perception is different actually. What the general public thinks is this hospital charge more, they work like a corporate sector, they don’t bother about patients, they bother only about the money.”

Prevention strategies

“When we are receiving patients inside our ER we have to make the attenders await outside. If we avoid attenders entering our department, we can avoid violence.”