Swearing patients take a toll on healthcare workers

Although many medical terms are long and difficult to pronounce, medical settings are punctuated with words familiar to most of us – being sworn at is an occupational hazard for healthcare workers. Exactly how often does it happen? A new review published in Aggression and Violent Behaviour by Teresa Stone and colleagues finds one study suggests rates as high as three incidents per shift in a mental health setting; in other contexts, the rates appear lower, but even a lower estimate suggests one in three workers experience one or more incidents a week, with seven per cent experiencing this "continuously".

So swearing is common enough, but its effects are far from negligible. It is more likely to provoke persistent negative feelings in health workers than even physical aggressions, as well as resultant problems with sleep and depression, and a greater likelihood of their seeking treatment or even a new role. Healthcare workers are oriented to care for and ease the suffering of their patients, which can make receiving vitriol from them particularly hard to shake off; Stone notes that training simulations to deal with difficult patients rarely include offensive content, meaning that first encounters often happen on the job.

Being sworn at bothers workers less when they perceive less or no intention to harm, such as when the patient is unable to control the utterance.  A classic example of this is coprolalia, where obscenities are generated in an explosive manner in response to surprise or stress, such as can happen with patients with Tourette Syndrome, for instance (although note only around ten per cent of those with TS experience this). Other examples include patients with language impairment due to left hemisphere brain damage, such as those with aphasia (in whom the production of swearwords is largely intact, often standing in for unavailable words), along with patients with dementia, traumatic brain injury, and of course, those in high distress or pain.

Pain is a good reason for expletives, as research has shown people can cope longer with pain (40 extra seconds with their hand in an ice bucket) when voicing swear words as opposed to non-swears. Habitual swearers are less likely to experience a benefit, suggesting they have habituated to what is meant as an infrequent venting of distress, a verbal form of an animal's howl. Other non-toxic reasons for swearing include releasing emotions, certainly in young men with stronger taboos around crying, and as a sign that members of a group have reached the stage where they can safely play with boundaries (true for healthcare workers and patients). However, Stone also notes evidence that swearing as a coping mechanism can turn potential supporters away from you.

Health workers may sometimes find using expletives a necessary part of their job, for example, to increase understanding by using informal speech that parallels that of a younger patient, although swearing directed at patients is obviously discouraged. Observation of staff group therapy sessions also shows workers using profanities to a high degree in this context. However, we don't have a clear picture of whether swearing is actually useful for them, either in processing events or in lessening the sting of future ones.

Accident and Emergency, the department with the highest rates of swearing, is often busy during the holiday period. If you find yourself attending, spare a thought for the staff and direct your expletives away from them. Perhaps towards Uncle Darrell's garish Rudolf cardigan, the one with the ever-fucking-flashing nose.

Further reading

Stone, T., McMillan, M., & Hazelton, M. (2015). Back to swear one: A review of English language literature on swearing and cursing in Western health settings Aggression and Violent Behavior, 25, 65-74 DOI: 10.1016/j.avb.2015.07.012