Amra Zalihic, M.D., Ph.D, Adna Zalihic Pita, M.D.

We witness aggressive behaviors of patients towards health care workers more frequently. The health care reform in Bosnia and Herzegovina is still ongoing. For eleven years, family medicine is functioning (or, at least trying to function), in the way that is functioning  in most western countries. Before the establishment of the family medicine model in Bosnia and Herzegovina, there was a general medicine model where doctors handled very few things. Their basic work was to to refer to specialists and to prescribe medications according to the advices of specialists.The systme was not financially viable and a reform was necessary. Doctors and nurses were educated but patients were not. Our clinics are still overloaded, our specialists in family medicine still do not do the work they are trained to do because they are overwhelmed in overcrowded clinics. Patients still trust more to so called “doctors from the hospital.”

Clinics try to see patients by appointments only. However, a lot of patients come without making appointments. Usually, those who are not scheduled have to wait. Does waiting make them aggressive? The truth is, most patients come in with their own view of the problem and it’s solution, which very often does not coincide with a medical opinion. If they do not get prescriptions they want to get or if hey are not referred to a desired specialist-consultant, they may become irritated and aggressive. If the staff is unpolite it may further aggravate them.
We surveyed 60 medical professionals of the Health Care Mostar and 58 of them encountered aggressive patients. Aggressive patient were mostly men. Episodes of aggressive behavior were mostly observed in the morning and were usually against nurses. Most aggresive patients suffered from psychiatric conditions or hypertension.

It is disturbing that 96.6% of surveyed health care workers encountered aggressive patients at their workplace. What make patients aggressive?