title: Violence and abuse faced by junior physicians in the emergency department from patients and their caretakers: a nationwide study from Pakistan.
abstract: BACKGROUND
  Across the globe, physicians in the emergency department (ED) are subject to violence by patients and visitors. This has been shown to have negative effects on patient care and physician performance.
  
  
  OBJECTIVE
  This study was conducted to determine the magnitude of the problem in a developing country, to examine the effects of ED violence on physician satisfaction and performance, and to identify underlying etiologies and potential solutions.
  
  
  METHODS
  This nationwide cross-sectional study examined physicians-in-training (n = 675) in the EDs of nine major tertiary care hospitals in Pakistan.
  
  
  RESULTS
  The study reveals a significant problem, with 76.9% of physicians facing verbal (65.0%) or physical (11.9%) abuse from patients or their caretakers in the previous 2 months. Male physicians were more likely than female physicians to be victims of such episodes (p < 0.05), as were physicians who had spent more than 60 h in the ED in the past 2 months (p < 0.0001). Reduced job satisfaction and a decline in the quality of job performance were reported by 40.7% and 44.3% of physicians, respectively. Junior trainee physicians were more likely to report impairment in job performance when compared to their senior colleagues (p = 0.014). Patients' lack of education, overcrowding in the ED, and lack of coverage by security staff were identified as the major areas that need attention to address the problem.
  
  
  CONCLUSIONS
  This study provides further evidence of the global prevalence of the problem, with the first nationwide epidemiological study performed in a developing country.
authors.affiliation: Department of Community Health Sciences, FMH College of Medicine and Dentistry, Lahore, Pakistan.
authors.forename: Nabil Mahmood
authors.initials: NM
authors.lastname: Mirza
authors.forename: Ali Imran
authors.initials: AI
authors.lastname: Amjad
authors.forename: Abu Bakar Hafeez
authors.initials: AB
authors.lastname: Bhatti
authors.forename: Fatima
authors.initials: F
authors.lastname: tuz Zahra Mirza
authors.forename: Kashif Shakoor
authors.initials: KS
authors.lastname: Shaikh
authors.forename: Jawad
authors.initials: J
authors.lastname: Kiani
authors.forename: Muhammad Muneeb
authors.initials: MM
authors.lastname: Yusuf
authors.forename: Muhammad Umair
authors.initials: MU
authors.lastname: Khan
authors.forename: Muhammad Enoos
authors.initials: ME
authors.lastname: Nazir
authors.forename: Qazi
authors.initials: Q
authors.lastname: Assad
authors.forename: Ayesha
authors.initials: A
authors.lastname: Humayun
authors.forename: Ismaa Ghazanfar
authors.initials: IG
authors.lastname: Kiani
authors.forename: Sami Imran
authors.initials: SI
authors.lastname: Amjad
authors.forename: Sardar Zakariya
authors.initials: SZ
authors.lastname: Imam
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003441:Crowding; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D010154:Pakistan; D012307:Risk Factors; D012637:Security Measures; D012737:Sex Factors; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult