Violence Against Doctors by Patients and Their Relatives in Hospital Settings: A Narrative Review of Risk Factors,...

Workplace violence against doctors has become an increasingly important concern in hospital settings, particularly in emergency departments and high-volume tertiary hospitals where clinical urgency, emotional distress, overcrowding, and resource limitations commonly intersect. Patients' relatives and companions represent a particularly important group in this context because they often function as caregivers, advocates, financial decision-makers, and intermediaries between the patient and the healthcare system. Their aggressive reactions may be triggered by fear, uncertainty, poor prognosis, perceived delays, unmet expectations, or inadequate communication. This narrative review synthesizes current evidence on violence against doctors by patients and their relatives in hospital settings, with emphasis on risk factors, communication failures, psychological and system-level drivers, consequences, and prevention strategies. A structured Scale for the Assessment of Narrative Review Articles (SANRA)-guided narrative methodology was used to review relevant literature from PubMed/MEDLINE, ScienceDirect, SpringerLink, BMJ Open, PubMed Central, Google Scholar, and institutional sources such as the World Health Organization. Included sources addressed workplace violence, patient or relative aggression, emergency department violence, doctor-patient communication, burnout, and mitigation strategies. The evidence indicates that aggression toward doctors is usually multifactorial and can be understood through both organizational behavior and patient-provider conflict perspectives. From an organizational perspective, violence may arise when overcrowding, staff shortages, long waiting times, limited resources, weak security systems, and inadequate reporting mechanisms create a high-pressure clinical environment. From an interpersonal conflict perspective, aggression may develop when relatives' expectations, emotional distress, and need for information are not aligned with clinical realities, triage priorities, or available hospital resources. Communication failure appears to be one of the most modifiable drivers of aggression, particularly when relatives receive inconsistent or insufficient information about diagnosis, prognosis, delays, or clinical priorities. The consequences of violence extend beyond immediate harm and include anxiety, burnout, reduced morale, defensive medical practice, disruption of team functioning, underreporting, and compromised patient safety. Overall, violence against doctors by patients and their relatives should be approached as both an occupational safety issue and a healthcare quality problem. Effective prevention requires integrated hospital-level strategies, including communication training, structured family updates, visible triage explanations, waiting-time communication, environmental safety measures, incident reporting systems, leadership accountability, and post-incident support. Future research should examine patients' relatives as a distinct group, particularly in emergency departments, tertiary hospitals, and resource-limited healthcare settings.