Review: Patient aggression towards receptionists is a serious workplace safety concern

Reviewed by Danielle Ellis, B.Sc.Jul 6 2023

Patient aggression towards receptionists working in general practice is a "serious workplace safety concern," concludes a review of the available published evidence, published in the open access journal Family Medicine and Community Health.

Not only does it affect the wellbeing of the individuals concerned, but it also has operational effects by boosting levels of workplace absenteeism and the numbers of staff leaving the healthcare workforce, say the researchers.

Acts of incivility perpetrated against general practice staff, including doctors, are common, but few studies have included the perspectives of the receptionists, say the researchers.

In a bid to plug this knowledge gap, they trawled research databases for studies published in English at any time that addressed receptionists' experiences of patient aggression in primary care.

From an initial haul of 274, 20 relevant studies, published between 1970 and 2022, were included in the review. Eleven of the studies were from the UK, 4 from Australia, 2 from Spain, 2 from the USA, and 1 from Ireland.

Eighteen were peer reviewed journal articles, with one doctoral thesis and one research institute report. A range of study designs were used. Twelve were considered to be high quality.

The studies included 4107 participants, around one in five of whom (21.5%; 882) were current or recent general practice receptionists.

Every study reported that patient aggression towards receptionists was a frequent and routine occurrence in general practice, particularly verbal abuse, hostility, and use of racist, ableist, and sexist insults.

Nine studies reported acts of physical violence towards receptionists, although these occurred much less frequently than verbal abuse. But some acts were very serious, and included being hit, shaken, held at gunpoint, stalked, and threatened with a razor blade.

Receptionists most often attributed the triggers for patients' aggression and hostility to frustrations with appointment scheduling and admin systems; errors; delayed access to doctors; and prescription refusal.

Receptionists usually tried to placate patients to avoid the situation from escalating, but at the cost of their own wellbeing and workplace productivity. Patient aggression was the most difficult part of their role, they said.

Such incidents prompted a range of negative feelings. And over the long term, direct and indirect exposure to repeated patient aggression was reported to lead to burnout and fatigue.

Strategies that minimised pinch points for patients, such as streamlined and flexible scheduling systems, early availability of appointments, and consistent patient management practices, seemed to curb the likelihood of aggressive/hostile behaviours.

And receptionists felt better able to manage patient aggression if they had been given relevant training, had confidence in their de-escalation skills, and if they could refer to formal policy and rely on back-up from management and clinical colleagues.

There was, however, little coordinated support for general practice reception staff on the receiving end of patient aggression, with only a small proportion given professional counselling.

The researchers acknowledge that their study included research conducted over a 40 year period during which time technological advances have significantly changed the duties of the general practice receptionist.

But they insist: "Our study has highlighted that the experiences and wellbeing of general practice receptionists are under-studied in general, and even in research about general practice reception, receptionists are under-represented as participants."

And they conclude: "Patient aggression towards reception staff is a serious workplace safety concern for general practices and negatively affects healthcare sector function more broadly.

"Evidence-based strategies to prevent, manage, and mitigate the harms of patient aggression towards general practice reception staff are urgently needed."