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How dangerous is after-hours medicine?


Around half of all doctors who provide after-hours house call (AHHC) services have experienced aggression in their work over the past 12 months, according to the first-ever Australian study on the subject.

Researchers from Griffith University surveyed 300 doctors employed by one of Australia’s largest AHHC providers, finding that 47% had experienced an instance of aggression over the past year. Most common was verbal abuse (48% of cases), followed by threats (27%) and vexatious complaints (13%). Property damage, physical violence, sexual harassment and stalking were all also reported by doctors.

The odds of having experienced aggression didn’t vary greatly according to gender, although female doctors were more likely to say they were concerned or anxious about aggressive behaviour in the course of their work. Overall, over 90% of doctors said they were concerned about aggression and 75% said they were apprehensive about it.

The patients themselves were the most common source of aggression (52%), followed by family members (30%) and friends of the patient (18%). To lessen the likelihood of aggression from friends and family, the researchers suggest making an effort to engage them more, when permitted by the patient.

Doctors with postgraduate fellowships were considerably less likely to have experienced aggression, an interesting finding that the study authors say probably reflects the greater training that these doctors had compared with non-fellows.

But although doctors working in AHHC services are clearly at risk of being on the wrong end of aggressive behaviour, is it any worse than what a regular-hours GP might endure? Perhaps not, the study authors say. Two studies from NSW and one from Victoria actually recorded higher levels of aggressive behaviour aimed at GPs working regular hours from their own premises. And the 47% figure for AHHC doctors is roughly the same as reported for hospital-based doctors in a 2004 study from northern NSW.

After-hours medicine certainly has a reputation for being more dangerous than other types of medical practice, but that perception may well be wrong, the researchers say.

You can access the full study here.