“One reason health care providers are reluctant to report these is that we have compassion for our patients, and we don’t want to treat patients like they’re criminals or the enemy,” Phillips said. “So we probably make excuses when we shouldn’t, and we overlook patients who are intoxicated or on drugs, and other patients who have altered mental status because of chronic dementia or acute delirium. They are already vulnerable, and we don’t want to treat them as if they are criminals.”

Phillips became interested in the issue after being assaulted twice within the past five years. The first time was while training in a Chicago hospital where an intoxicated patient “spit blood in my face knowing he had hepatitis C. I was forced to undergo six months of testing. I was never asked if I wanted to file a police report or press charges.”

The second time was in a community hospital when he asked an emergency department patient to stop screaming and cursing because there were two children in the next stall. The woman threw her cell phone, struck him in the face, and then stood up and spit on him in the presence of a police officer. She was ultimately convicted of assault and battery. “The majority of health care providers who have been assaulted don’t feel that their concerns are taken seriously,” he said.

Phillips said the best solution isn’t clear because little research has been done on the best ways to thwart attacks. Some possibilities include being tough on verbal assaults; acting aggressively against such cases may prevent them from escalating; changing the law to make a physical attack on a health care worker a felony; and redesigning patient charts to flag past instances of violence, a system in use in the Veterans Affairs system.

Metal detectors might appear to be an option. A 2003 study reported that one emergency department with a metal detector confiscated 3,446 weapons in 8 months. But firearms were seldom found. Most of the weapons were knives. And the system misses a lot of weapons because they’re often carried by the patients, who aren’t screened because they come to the emergency department on a metal ambulance stretcher.

“Metal detectors tends to be the knee-jerk reaction to any major violence that takes place, especially when a weapon is used,” Phillips said. “But there’s not any evidence that reducing the number of weapons, reduces violence because so much of the violence isn’t committed with a weapon. It’s committed with fists and feet.”