Workplace violence and harassment

• The policy must be in writing and displayed at a conspicuous place in the workplace if there are six or more employees, or where an inspector orders it be done
• The policy must be reviewed at least once a year

Assess the risks of workplace violence that may arise from the nature of the workplace the type of work or the conditions of work.

• The assessment must take into account:
  • Circumstances that would be common to similar workplaces
  • Circumstances specific to your workplace
• The risks of workplace violence must be reassessed as often as necessary to ensure that the related policy and program continue to protect workers from workplace violence. It is recommended that this is done at least once a year
• An assessment or reassessment may be ordered in written form by an inspector

• The Joint Health and Safety Committee or a Health and Safety Representative should be advised of the results, and provided with a copy of the assessment or reassessment is in writing
• If there is no Joint Health and Safety Committee or Health and Safety Representative, the workers should be advised of the results, and provided with copies on request or instructions on obtaining copies if the assessment or reassessment is in writing

• This must include:
  • Measures and procedures to control the risks identified in the assessment as likely to expose a worker to physical injury
  • Measure and procedures for summoning immediate assistance when workplace violence occurs or is likely to occur
  • Measure and procedures for workers to report incidents of workplace violence to the employer or supervisor
  • How the employer will investigate and deal with incidents or complaints of workplace violence
• According to the Ministry of Labour document Workplace Violence and Harassment: Understanding the Law it is suggested that the program should be reassessed if:
  • A reassessment of risks indicates revisions are needed
  • Authorities indicate the program is insufficient
  • A violent incident shows that the measures or procedures are inadequate and/or
  • The workplace’s response to a violent incident shows that the reporting or investigation procedures are insufficient

Provide a worker with information and instruction that is appropriate for the worker on the contents of the policy and program with respect to workplace violence.

• This may include personal information, related to a risk of workplace violence from a person with a history of violent behaviour if:
  • The worker can be expected to encounter that person in the course of his or her work and
  • The risk of workplace violence is likely to expose the worker to physical injury
• Note that an employer or supervisor must not disclose more personal information than is reasonably necessary to protect the worker from physical injury

Prepare a policy with respect to workplace harassment.

• The policy must be in writing and displayed at a conspicuous place in the workplace if there are six or more employees, or where an inspector orders it be done
• The policy must be reviewed at least once a year

Create and maintain a program to implement the workplace harassment  policy. This must include:

• Measures and procedures for workers to report incidents of workplace harassment to the employer or supervisor
• Set out how the employer will investigate and deal with incidents and complaints of workplace harassment

If an employer becomes aware, or ought reasonably to be aware, that domestic violence that would likely expose a worker to physical injury may occur in the workplace, the employer shall take every precaution reasonable in the circumstances for the protection of the worker.

A person may refuse to do work or particular work where he or she has reason to believe that workplace violence is likely to endanger himself or herself.

• An inspector is to decide whether a circumstance is likely to endanger the worker or another person, with respect to the refusal to work

If a person is disabled from performing his or her usual work or requires medical attention because of an incident of workplace violence, but no person dies or is critically injured, the employer shall within four days of the occurrence give written notice of the occurrence containing the prescribed information to the Joint Health and Safety Committee, a Health and Safety Representative, and any involved union.

The CPSO’s policy on Ending the Physician-Patient Relationship expressly provides that physicians are not required to comply with the expectations set out in the Policy where, “in the physician’s judgment, the patient poses a genuine risk of harm to the physician, the physician’s staff, or to other patients. In these circumstances, physicians are under no obligation to engage with the patient prior to ending the relationship.”

A physician can end the doctor-patient relationship as long as the professional obligations governing termination of that relationship are met. 

Every situation needs to evaluated on its own merits, but examples of situations which may lead a physician to end the relationship include:

• Where there has been a significant breakdown in the physician-patient relationship
• Where the physician wishes to decrease their practice size
• Where a patient has been absent from the practice for an extended period of time
• When a patient has refused to pay an outstanding fee
• Where the patient has sought care outside a rostered practice

The CPSO policy provides further examples of circumstances that may lead to the breakdown in the doctor-patient relationship including:

• Behaviour which significantly disrupts the practice
• Oher forms of inappropriate behaviour, including abusive or threatening language

The decision to end a doctor-patient relationship is necessarily fact-specific and will often depend on the particular patient at issue. Through the CPSO policy referenced, the College provides guidance for physicians regarding their professional obligations when ending this relationship. There are general expectations of physicians in these circumstances – such as the application of clinical judgment and compassion and that reasonable efforts are made to resolve the situation in the best interests of the patient – and there are specific expectations, such as those relating to patient notification and the provision of interim care. The policy also recognizes physicians may not always need to provide the rationale for discontinuing the relationship with the patient where there is a genuine risk of harm.

If you have further questions about ending the doctor-patient relationship, the contact the CMPA.

It is not a breach of patient privacy to call the police if you have been physically threatened or assaulted. Under PHIPA, Personal Health Information (PHI) may be disclosed to facilitate an investigation or where the disclosure is necessary to reduce or eliminate a significant risk of bodily harm to a person or group of persons.

Any report to the police should disclose only the nature of the incident and the minimal amount of personal health information required to prevent or reduce the risk of harm.

If you have concerns about calling the police, or what to disclose, you are encouraged to contact the CMPA for advice where practicable. There are certain legal measures that may be taken to protect a physician in circumstances where a patient is exhibiting aggressive behaviour or threatening a physician’s personal safety.

Physicians and their staff have a right to a safe work environment. Unfortunately, patients and their families may engage in abusive behaviour from time to time. Physicians are entitled to have a zero-tolerance policy with respect to abusive and disruptive behaviour.

If personal safety is not a concern, disruptive patients should be clearly told that their behaviour is not acceptable. If a policy exists, it is helpful to have it posted in the office prominently. Disruptive patients should be advised of the consequences of any recurrence (e.g., ending the doctor-patient relationship).

If there is repetitive disruptive or abusive behaviour, or if there is a major or severe incident, the physician should consider ending the doctor-patient relationship in accordance with the CPSO’s policy.

If there is a physical threat or assault the physician may notify the police or, in a hospital setting, a security guard. Typically, the report to the police should disclose only the nature of the incident and Personal Health Information required to prevent the harm.

If you have concerns about calling the police, or what to disclose, you are encouraged to contact the CMPA for advice where practicable. There are certain legal measures that may be taken to protect a physician in circumstances where a patient is exhibiting aggressive behaviour or threatening a physician’s personal safety.

In all cases, the physician should document disruptive and/or abusive behaviour clearly and factually in the chart.

There are many ways to increase the safety of your medical office and lower the risk to yourself, your staff and your patients. Choosing how to arrange your practice will inevitably be a personal exercise, but below are some helpful measures to assist in creating a safe environment at the office:

Create office policies:

• Consider creating and posting a policy about what behaviour is acceptable and the potential consequences for any violations by patients or staff. The policy should be posted in prominent areas of the office so that it is brought to the attention of patients

• Although it is generally necessary to meet with patients in private, physicians must be mindful of their own safety and may want to ask a staff member or colleague to join them, where appropriate

• Physical office layout – consider arranging office furniture close to doors or exits to avoid anyone being cornered and to allow a rapid exit

• Controlled access – consider controlled access to certain areas (code entry) and physician and information technology security for records, technology, and equipment

• Medication storage – ensure that medication is stored in designated areas and that controlled substances are properly secured.

• Security systems – security alarms are effective, as are panic buttons. The use of video surveillance engages privacy issues that need to be addressed directly with the CPSO and the Ontario Information Privacy Commissioner in advance as there are some spaces used by patients where video surveillance is not permitted, and notice of using video surveillance should be posted prominently within the areas being surveilled

• Lighting – bright lighting near entrances, exits and parking lots allow for better visibility
• Emergency procedures – consider creating and implementing emergency response procedures that staff are trained to execute

If you receive a threat or comment containing bullying or harassing language on social media, the best course of action is to disengage. Do not respond. To respond could potentially invite further harmful comments.

If you feel you must respond, message the sender privately and calmly ask them to stop. If you feel you must post a public response, do not single out the sender and do not tag them in your post. Post a response to the theme, content or sentiment of the message.

If you receive a threat or comment containing bullying or harassing language on social media from an account you do not wish to see content from anymore, you can mute or block the sender.

When you mute or block an account, the account you mute or block will not be notified that you have muted or blocked them. When you mute or block an account you will not see any updates from that account anymore. The difference between muting and blocking is that a muted account can still view your activity while a blocked account cannot.

View a guide on how to mute accounts.
View a guide on how to block accounts.

If you feel the comments are in violation of the email service or social media platform’s terms of service or are persistent despite your attempts to disengage, you can report the abuse to the social media platform where the comments or messages were posted or the email service used to send the messages.

Keep copies or screenshots of all messages, posts, emails or comments that concern you and, if possible, document who made each of the comments.

• Access Twitter’s harassment policy.
• Access Facebook’s harassment policy.
• Access Instagram’s harassment policy.
• Access TikTok’s harassment policy.
• Access YouTube’s harassment policy.
• Access Microsoft’s harassment policy.
• Access Apple’s harassment policy.
• Access Google’s harassment policy.

In situations involving aggressive and/or threatening behaviour, you are strongly urged to contact your local police for assistance and guidance. Any copies or screenshots of interactions you have kept will assist the authorities with your case.

OMA Legal Services is also available to discuss options about what you can do if you receive threats. OMA Legal Services can be contacted at legal.affairs@oma.org.

If you need additional assistance managing issues with violence and harassment, the College of Physicians and Surgeons of Alberta and Doctors of BC have guidance on the best ways to protect yourself. Receiving threats and harassment can take a toll on your mental health and well-being. Below are some resources to help you consider if maintaining a public social media profile is right for you and supports you can access if you’re feeling overwhelmed.

• Managing threatening and violent patient behaviour (CPSA)
• Sound Mind: Threats, harassment and trolls: Is being a “public” medical voice worth it? (CMA podcast)
• Preventing Violence in Healthcare (Doctors of BC)
• Violence preventing guide for community clinics (Doctors of BC)
• Physician Health Program