As the COVID-19 pandemic and vaccination campaign continues, we have observed an escalating trend of intimidation and disrespect towards physicians stemming from frustration with pandemic restrictions and COVID-19 vaccination. We are hearing from physicians indicating an increasing volume and intensity of concerning attitudes from patients and visitors. Currently, this is being driven by patients who are feeling forced or coerced to get a COVID-19 vaccine, but have fears or concerns about vaccination. 

Doctors Manitoba is very concerned about this trend, and we anticipate it may continue to escalate in the short-term as physicians continue to care for COVID-19 patients, apply pandemic precautions in their practice, and contact patients about vaccination. We want all physicians and medical learners to know that we are here to support you, every step of the way.

While the vast majority of Manitobans trust, support and appreciation physicians, a small segment of the population has directed their skepticism and frustration about the pandemic towards doctors and other health care workers. At times, physicians have felt personally threatened and fearful for their physical safety. 

While Dr. Brent Roussin has faced repeated threats as the medical face of the pandemic response, unfortunately these incidents are more widespread. The examples we have documented involve front-line physicians, such as:

• Repeated social media bullying and threats.
• Protests at health facilities and offices.
• Intimidating and threatening letters delivered to physicians at their clinic, their personal residence, or on their vehicle.
• Patients taking photos and video without their consent.
• Disrespectful and aggressive in-person behaviour, such as shouting and spitting.

→ If you have experienced or observed an incident like this, report it to us now.

The rise in threats, abuse and violence towards physicians and health care workers is not unique to Manitoba, and has been observed around the world. The Red Cross documented hundreds of violent incidents around the world in the first few months of the pandemic. In the UK, physicians and staff contacting patients about vaccination have faced abuse. The British Medical Association’s research earlier this year found a very concerning level of abuse against doctors and colleagues. The Associated Press documented increasing threats towards health care workers across the U.S. Thankfully, we have not heard of any instances of physical assault to a physician in Manitoba, though there have been reports of this in other jurisdictions. 

What should you do?

There are several steps physicians can take to ensure a safe and respectful workplace and minimize the potential for pandemic- or vaccine-related threatening behaviour. We have compiled the following suggestions to help you in your practice.

1. Understand the level of risk for you, your peers and your staff.

• Reflect on your experience and ask your peers and employees about their experience. Has anyone faced any bullying, threats, intimidation, disrespect or aggression related to COVID-19 or vaccination? Don’t brush off past disrespectful behaviours as they can escalate in the future. Do not assume nothing has happened just because you haven’t heard about it. 
• Consider views about the pandemic and vaccination in your local community. Are there signs of disrespectful or threatening behaviour occurring, even if not directed at physicians? 
• Contemplate what could reasonably happen in waiting rooms, common areas and exam rooms, as well as protests, threatening phone calls or correspondence. 

2. Review and update existing safety policies and procedures.

All health facilities, including physicians’ offices and clinics, are required to have a violence prevention policy in place under provincial workplace safety rules. Start by reviewing any plan already in place for violence prevention or respectful work environments. Consider the level of risk and any adjustments to the policy that should be considered. Actions to consider may include:

• Training all physicians and staff on tactics to de-escalate potentially serious incidents from occurring. Maintain an empathetic, non-judgmental and non-confrontational approach with patients and visitors whenever possible, including those with strong views about pandemic restrictions or vaccination. This can help to avoid threatening and unsafe situations. Physicians and their staff should reinforce that they use medical evidence to guide the advice they offer to patients, and they respect person choice and informed consent. Avoid labels and terms that could escalate a situation, including ​“vaccine hesitant” ​“anti-vaxxer,” ​“anti-masker” or ​“COVID denier.” 
• Posting notices in highly visible locations about respect and safety such as THIS. This can help you and your staff to de-escalate situations by referring to the clinic position on disrespectful behaviour or threats. Patients or visitors who do not comply could be warned and then asked to leave. 
• Develop a plan for situations that could become unsafe. This could involve a plan for what to do if patients start yelling or becoming threatening, and what to do if protestors show up (e.g. lock the door, call the police, and call scheduled patients with advice about accessing care). It could also involve considering clinics space to promote physician and staff safety, such as placement of furniture in exam rooms and ensuring the provider is closer to the door. In some places where the risk has been higher, panic buttons have been used. 

In some jurisdictions, health care workers avoid wearing clinical clothing and ID outside of the workplace to avoid potentially hostile interactions.

3. Communicate the plan with all physicians and staff.

Take the time to communicate safety plans with physicians and staff. Invite questions and create an open dialogue to ensure the safety plan remains up to date. For policies and procedures to be followed there must be buy-in, and processes must be understood.

4. Report incidents ASAP!

If there is an imminent threat to health or safety, contact the police immediately. 

We care about you and your colleagues. We are now tracking incidents throughout the province to understand the safety risks physicians are facing and to inform our next steps. We can assist you in problem-solving your specific situations so you can feel safe and provide the best care possible to your patients. Report any incidents to Doctors Manitoba, including past incidents, whether or not they are related to COVID-19. This includes incidents of bullying, threats, aggression, violence or intimidation. 

→ Report an incident to us now involving bullying, harassment, threats, vandalism, abuse, violence or intimidation.

5. Seek Support and Promote Psychological Safety.

While avoiding physical abuse and violence is a priority, do not underestimate the impact of verbal abuse, harassment and intimidation. These tactics can take a toll and should not be brushed off. 

Remember that physicians and those in your household have access to special supports, including a 24/7 Physician and Family Support Program. Don’t hesitate to access any of these resources. Find out how.

You can also review our Guide to Staying Well During the Pandemic and find strategies that help you cope and build resilience. Remember, being resilient does not mean you don’t need to seek support and assistance; in fact, it means the opposite. 

What you can and can’t do

According to the CPSM, physicians cannot refuse to treat a patient who is unvaccinated or refuses to be vaccinated. CPSM’s Code of Ethics and Professionalism requires doctors to ​“Respect the decisions of the competent patient to accept or reject any recommended assessment, treatment, or plan of care.” In CPSM’s vaccination FAQ, they make it clear that ​“competent patients are entitled to make the decision to not be vaccinated. This cannot be used as a reason to deny any medical care.“On the other hand, if the patient’s conduct goes beyond simply refusing the vaccine, or expressing to you their views, concerns or frustration about the pandemic or vaccine, you may have adequate grounds to terminate the patient relationship. The CPSM allows you to terminate a professional relationship with a patient immediately if the patient:

• Poses a safety risk to you, your staff, or other patients;
• Is abusive to you, your staff or other patients; or
• Does not respect professional boundaries or acts in an inappropriate manner.

It is our view that patient behavior including violence, verbal abuse, threats, or spitting may well be sufficient grounds to end the relationship. You should carefully and factually chart the behavior, and in all but the most extreme cases you may wish to consult the CPSM to discuss the reasons why you wish to terminate the relationship. Even if you have reason to terminate the relationship, you may still have some ongoing duties to the patient (for example, in relaying the results of diagnostic tests) and we encourage you to review the CPSM Standards.

Resources and Further Reading

• When Physicians Feel Bullied of Threatened (CMPA)
• COVID-19 and Violence Against Health Care — Safer COVID-19 Response: Checklist for Health-Care Services (International Committee of the Red Cross)
• Navigating Attacks Against Health Care Workers in the COVID-19 Era (JAMA)
• COVID-19 exacerbates violence against health workers (The Lancet)
• Vaccine Hesitancy GuideDesigning tailored intervention to address barriers to vaccination (PHAC)
• Motivational interviewing: A powerful tool to address vaccine hesitancy (PHAC)