Three-quarters of Canadian family doctors say they suffered at least one incident of major abuse at the hands of a patient, according to a new study.

The study, the first national look at violence in doctor's offices, was released Friday in the journal Canadian Family Physician.

Long waits for medical care may leave patients angry, frustrated and more likely to lash out at, said Dr. Bo Miedema. (CBC)

Researchers randomly selected 3,802 family physicians to survey by mail between November 2008 and April 2009. Of the 774 who responded, 98 per cent said they had experienced at least one incident of "minor" abuse, and 75 per cent reported "major" abuse during their career, including being sexually harassed or physically threatened by a patient. On average, respondents were in mid career.

Nearly 40 per cent said they had experienced at least one incident of "severe" abuse, including being physically attacked, injured, sexually assaulted or stalked, the researchers found.

"One physician had a house burned down because of an angry patient," study author Dr. Bo Miedema of Dalhousie University's family medicine teaching unit in Fredericton. "A number of physicians talked about having slashed tires. We had five per cent who indicated that assault had caused bodily harm."

Long waits for medical care may leave patients angry, frustrated and more likely to lash out, Miedema said.

Often people are scared, can't get timely service, and turn their anger towards those around them, agreed Dr. Donna Manca, a family physician with a teaching practice at the University of Alberta in Edmonton. Usually doctors can work around these patients, she said.

But doctors may also become the focus of delusions or obsessions of their patients. It happened to Manca in 1996 when a woman felt Manca had shrunk her brain and declared she wanted to kill her. Physicians may be abused in the context of patients who have mental health issues or problems with substance abuse, said Dr. Francine Lemire. (CBC)

A patient left threatening messages on Manca's home and office phones, stalked her and even filed a false assault complaint with police.

"Fortunately, I had tape-recorded some of the threats and they listened to that and it became apparent to them that I was the victim," Manca said.

Manca remained afraid for herself and family. She installed a security system, learned martial arts, and stopped visiting patients at nursing homes at night.

The abuse "raises depression and anxiety in physicians," Miedema said. "Some physicians told us that they really stop enjoying the job altogether."

If doctors experience many incidents, in many cases they will leave active practice and opt to work in a non-clinical setting without seeing patients. In other rare cases, doctors leave the profession altogether, Miedema said.

For Manca, zero tolerance for abuse and doctors turning their backs on patients is not the answer.

"We're dealing with people when they're ill and hurting. It's part of the job," Manca said, adding the way doctors are sometimes treated by patients needs to be recognized and talked about, with new strategies developed to protect them.

Miedema hopes the findings will lead to new support and help for doctors experiencing abuse.

"This study has highlighted some serious issues that family physicians in Canada must deal with on a daily basis, and we hope that this study will be a foundation for discussion to make the practice setting in Canada safer for family physicians, more conducive to physician well-being, and physician retention in practice," the study's authors concluded.

The abuse can happen in the context of patients who have mental health issues or problems with alcohol or substance abuse, said study author Dr. Francine Lemire of the College of Family Physicians in Toronto.

Residents receive some training on how to deal with confrontations and make their offices safer, but "the data suggests that perhaps we need to do a little bit more in this regard," Lemire said.

The researchers admitted the response rate was low, and it could be argued that doctors who were abused were motivated to complete the lengthy survey, skewing the findings.

"Even if we were to assume, however, that none of the non-respondents had been abused, we would still be able to safely report that at least one in five family physicians is subjected to abuse at work, one in seven to a major abusive encounter, and one in 12 a severe abusive encounter," the researchers noted.