Marta (fictitious name of a health worker who prefers to remain anonymous) is afraid to go to her workplace. There is no shortage of reasons, neither for her nor for any of her companions. She works at CAP Piera, the primary care center in Catalonia where the most attacks on professionals have been reported in the last three years, from 2021 to 2023. Specifically, 30 (three very serious, 16 serious and 11 minor). Two of the three classified as very serious were physical attacks. For this reason, on February 22, there was a union rally in front of the center to demand the hiring of a security guard by Salut.
She has experienced some aggression firsthand and witnessed others where her colleagues were the victims. “On a personal level, I have received insults and some violent action [screams, slamming doors, throwing an object against the floor...], and more than once.” She explains that on one occasion she saw how a person grabbed a computer screen from the information desk, threw it at several workers and then grabbed a pair of scissors to try to stab them at the professional who was trying to stop her.
He regrets that violent episodes are frequent. “It's a constant. Sometimes it is not the patients who attack (whether physically or verbally), but rather their companions.” He says that they even have “a panic button” on each PC and that when someone presses it, an alarm goes off on all the computers in the center. “At that moment, our teammates came to try to apply pressure so that things wouldn't get any worse. "We all show up at the place of conflict, sometimes the behavior that has started does not escalate."
Given this scenario, it is not strange that he states that the professionals at the center are “afraid” to go to work. “Especially at night, when there are fewer staff,” she argues. She explains that one night, a colleague served a person who wanted a prescription. The professional did not do it “because it did not fit the pathology she presented.” After her refusal, the person became very angry and left. When the colleague finished her shift and went out to the parking lot, she realized that she was waiting for her with very bad intentions. “Fortunately, she was able to see it from afar and she re-entered the CAP.”
He assures that in the last ten years the attacks have increased, especially after the pandemic. And not only in its center. “There are several CAPs that in the last year (from January 1, 2023 to January 31, 2024) had more attacks than Piera,” sources from the ICS staff board of Central Catalonia explain to La Vanguardia. According to figures provided by these sources, in the EAP (primary care team) of Manresa, 24 attacks were reported (one of them physical); in Vic Nord's, 23 (a physicist); in the ACUT (continuous and urgent care) Bages-Berguedà, 18 (3 physical); 14 were registered in the EAP Manresa 4; in Capellades, 12; and in that of Santa Margarida de Montbui, 11.
Marta asserts that the aggressors are more daring with them. “We are the ones who suffer the most from violent actions.” The data from the latest National Observatory of Attacks on Doctors in 2023 prove him right. Two out of every three doctors attacked in the exercise of their work were women, who also received 70% of the insults and humiliations, 65% of threats, 58% of the physical injuries and 75% of the cases of harassment. , a gender gap that has increased year after year since 2016.
According to data from the Ministry of Health, in 2022 a total of 13,210 attacks were reported in the entire national health system (SNS), assuming 20.05 notifications of attacks per 1,000 SNS professionals. This represents almost 5 points more compared to 2021.
What explains why so many attacks occur at CAP Piera? It is important to take into account the socioeconomic environment, says Marta: “Piera has a part of society that suffers from significant socioeconomic deprivation. In addition, there is a fairly high rate of addictions and consumption of legal and illegal narcotics. This cocktail causes violent actions to grow.”
There is also the variant of the lack of doctors. “The fact that there is no continuity of care is one of the reasons why there are more attacks,” the ICS staff meeting points out. “Patients get angry when they see that they do not have a designated doctor and they always have to go to the emergency room, so they have no follow-up. If a person is followed by a health professional, be it a doctor or nurse, this creates more adherence, generating less tension. Possibly, the Piera CAP is the one that has had the greatest lack of professionals, at least in Anoia,” they add.
It must be taken into account that not all attacks are reported. “Professionals tend not to do it,” these same sources explain. Because? “Because the process is very arduous. We have asked to speed it up and do it in a different way, like when we notify other types of incidents. In this sense, Salut has informed us that they will carry out a pilot test in two CAPs, in Piera and in the CAP Bages Organyà, where a more agile process will be used.
To stop the number of attacks, the center is demanding that the department hire a security guard. It would not be the first CAP that has this figure. At the time, and as explained by the staff meeting of the ICS of Central Catalonia, they already managed to have it implemented in two other centers: one in the CAP Bages in Manresa and another in the CAP Osona in Vic. In the first there is surveillance from 8 a.m. to 8 p.m., on weekends and holidays 24 hours a day; while in the second at night.
From Salut, however, they do not seem to be very receptive judging by the response they have given to this editorial. “With regard to security and infrastructure, health centers have passive and active security measures," they argue. "They also have awareness and zero tolerance campaigns and campaigns against violence towards professionals at their disposal. Within the framework of prevention, the training plans for professionals also include several courses on how to act in crisis situations.”
They also add that "the ICS Catalunya Central and the basic prevention unit provide active support to the professionals of the Piera CAP following the prevention and action procedure in cases of situations of violence against professionals that the institution has applied since 2007" . And they point out that “the ICS plan, active in the Piera CAP, includes direct relationship actions between the risk prevention service and the affected person and health, psychological and legal support. In addition, there is periodic coordination between the center's management and the Mossos d'Esquadra."
