Verbal and physical abuse can create lasting mental health challenges for receptionists and other staff.
Ignore the toll of patient abuse on practice staff and risk losing precious time and money to workforce churn, Australian research warns.
According to a review covering around 40 years of literature looking at the experiences of general practice receptionists, frequent patient abuse – both physical and verbal – is a major contributor to burnout in practice support staff.
While patient-initiated abuse and hostility has been a mainstay of the medical administration workload for decades, the covid-19 pandemic exacerbated the situation.
RACGP vice president Dr Bruce Willett said that, in an early phase of the pandemic, there was a period of several weeks when at least one receptionist at his practice south of Brisbane would be reduced to tears each day.
“There is lot of turnover in the area of reception staff,” he told TMR.
“I think covid was a blip, but we’ve seen a gradual increase [in hostile] behaviour towards receptionists over several years now.”
Dr Willett also observed that violent and abusive patient behaviour in primary care followed a trend previously seen in emergency departments.
Riwka Hagen, founder of popular Facebook forum Practice Managers Network, told TMR that there had been a pointed increase in reports of aggressive behaviour in primary care over the last few years.
What was originally an uptick in patient aggression surrounding covid protocols and vaccination, she said, had morphed into something else.
“[Anger is now leaning] more towards the increase in private fees being charged,” Ms Hagen said.
“Patients who previously were able to tap into practitioners at no out-of-pocket cost can’t do that any more, so there’s aggression related to that.
“And there’s also just the fact that people can’t actually get in to see their providers – that’s another storyline that sits behind the aggression.”
The UQ-led research appeared in Family Medicine and Community Health last week and found that receptionists often felt disempowered in the face of hostile patients.
“The clinic receptionist is already recognised as being one of the lowest ‘prestige’ positions in the general practice workforce, with little authority, and the sector is far from achieving gender parity with an extreme over-representation of women,” the authors wrote.
They also found that the root causes of patient aggression toward receptionists arise from avoidable operational factors like scheduling and communication.
“The apparent reliance of general practice clinics on receptionists to develop their own de-escalation strategies and independently build resilience against patient aggression is concerning,” the researchers said.
Taken together, these factors can lead to higher levels of absenteeism and attrition, they concluded.
Ms Hagen said the modest pay rate received by most reception staff was often the final blow in terms of attrition.
“Why would I put up with this level of harassment, technical challenge and … tetchy doctors for a pretty ordinary wage, when I can be stocking shelves at the supermarket … without any of those kinds of pressures attached?’” she said.
“People vote with their feet. You get churn in the industry, low levels of skill acquisition and that corporate memory gets lost in terms of transferring those skills.”
The researchers noted that there was a general lack of studies evaluating different interventions to help shield reception staff from the negative impacts of abuse.
They did allow, however, that internal staff training on how to handle hostile patients is likely to improve receptionist mental wellbeing, even if it does not affect the actual frequency of hostile behaviour.
“People come in with a lot of problems; they might have mental health issues, they might have substance abuse problems … that sometimes cause or contribute to this bad behaviour,” Dr Willett said.
“Receptionists are trained about how to deal with them.
“But on the other hand, there are some people who come in who are just badly behaved, and I don’t think that society should be accepting that.”
