Workplace violence is not part of a doctor’s job

Barbara Sibbald's article1 regarding workplace violence highlights important deficiencies in our understanding of the effectiveness and appropriateness of interventions for this issue. She also points out circumstances through which, "violence becomes part of the job." The research in this area is limited for community pharmacists2 and pharmacy students3 but many experience verbal abuse as "part of the job". A survey sample of Australian community pharmacists (n=248) revealed that approximately one third had experienced verbal abuse monthly and 15% on a weekly basis.2 Bullying and intimidation was reported as occurring once per month by 15.7% and robberies were reported by 6.5%. The impact of violence was also significant with 19% reporting reluctance to return to work and over half reporting that they returned from work feeling anxious, angry, depressed, or irritable.2

The rise in opioid use and related harms experienced by Canadians over the past 10 to 20 years has been well documented and extensively discussed.4,5 Pharmacists are inextricably linked to prescribers (i.e., physicians and nurse practitioners) because of our role as stewards of the medication supply including controlled drugs and substances. Clinical circumstances (e.g., patient safety) and regulatory considerations (e.g., rules surrounding quantities, part-fills, and refills) can result in the pharmacist appearing to act in conflict with the patient's or the prescriber's (or both) intentions. We have found that significant tensions can exist among patients, physicians, and pharmacists within this complex phenomenon of opioid treatment and that issues such as verbal abuse, bullying, and intimidation may arise.6

Although forms of violence (e.g., robbery7,8) towards pharmacists in retail environments may differ from other health care professionals, shared similarities with practice characteristics and roles (e.g., working as sole practitioners or with few staff) may allow for the development of interventions that are transferrable among groups and settings. The opioid crisis presents us with an opportunity to more comprehensively understand violence and look at shared solutions in prevention.

References:

1. Sibbald B. Workplace violence is not part of a doctor's job. CMAJ 2017;189:e184. 2. Peterson GM, Tan SI, Jackson SL, Naunton M. Violence in community pharmacy in Australia: incidence and implications. Int J Clin Pharm 2011;33:264-272. 3. Rahim H, Shah B. Pharmacy students' perceptions and emotional responses to aggressive incidents in pharmacy practice. Am J Pharm Educ 2010;74:61. 4. Dhalla IA, Persaud N, Juurlink DN. Facing up to the prescription opioid crisis. BMJ 2011;343:d5142. 5. Canadian Centre on Substance Abuse. Prescription drugs. Available: http://www.ccsa.ca/Eng/topics/Prescription-Drugs/Pages/default.aspx. (Accessed 2017 February 28) 6. Murphy AL, Phelan H, Haslam S, et al. Community pharmacists' experiences in mental illness and addictions care: a qualitative study. Subst Abuse Treat Prev Policy. 2016;11:6. 7. The Canadian Press. 2 men wearing disguises allegedly rob 6 Toronto pharmacies over 2 weeks. Available: http://www.cbc.ca/news/canada/toronto/2-men-wearing-disguises-allegedly- rob-6-toronto-pharmacies-over-2-weeks-1.3943856. (Accessed 2017 February 28). 8. Woo A. All B.C. pharmacies must now store drugs in time-delay safes. Available: http://www.theglobeandmail.com/news/british-columbia/all-bc- pharmacies-must-now-store-drugs-in-time-delay-safes/article26375550/. (Accessed 2017 February 28).

Conflict of Interest:

None declared