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LAS VEGAS -- When it comes to the rise in harassment and violence against healthcare workers, pharmacists are no exception.

During a session at the Midyear American Society of Health-System Pharmacists meeting, a panel addressed these growing concerns for an audience of mostly pharmacists, many of whom work in clinical settings, and provided strategies for addressing patient harassment.

César, a clinical pharmacy manager for a healthcare system in Texas, who asked to be referred by his first name only because of a company policy that prohibits employees from talking to the press, said he came to learn ways to deal with this problem at work, which has recently become more serious.

"Before 5 years ago, I would have never had to deal with patient complaints to this degree, or reports of harassment," said César, who manages a team of over 20 pharmacists who work with patients in clinics. "But in the last 2 years, I've had five [complaints]," he added, noting that these were just the complaints filed formally, and don't count incidents that went unreported.

Brianna Bakken, PharmD, a pharmacy operations manager at Children's Wisconsin, who was chairing the lecture, shared statistics on harassment against pharmacists.

According to , nearly a third had experienced discrimination or harassment at work. linked patient bullying to increased stress and medication errors or near misses. The most common type of harassment reported were demeaning comments about race or ethnicity, which came mostly from male patients/customers.

More than half of Black male pharmacists reported receiving demeaning comments about race or ethnicity, and more than 80% of all pharmacists did not report these incidents, with over 40% saying this was because they didn't think it would result in any action.

According to a by Bakken and colleagues, some pharmacists were justified in their reasoning, with 89% of Black female pharmacists noting that they were dissatisfied with the results of reporting this harassment to an employer.

"We have a lot of BIPOC [Black, Indigenous, and People of Color] students," said César, "and so I've even had team members where the patient walks in and will be like, 'I want to see a real doctor,' and it's a female pharmacist or a Black pharmacist.

Julia Gilbertson, PharmD, a pharmacy resident at William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin, discussed the various strategies for reducing harassment from patients, including hospital policies and patient forms, like those at Penn State Health in Philadelphia or Emory Healthcare in Atlanta, which clearly state zero tolerance for requests to switch providers because of race, ethnicity, and gender presentation, among others.

She also noted that discussing such incidents with patients in the moment, using tools such as ERASE (Expect, Recognize, Address, Support, Encourage), could help address harassment of trainees. Panel members also emphasized the importance of intervening on a colleague's behalf, especially from a more senior position.

Another tool, "Cards Against Harassment," of comebacks to harassing comments, such as "Next time, just say 'hello,'" and "My age is none of your business. I can assure you I am old enough to have completed a doctorate degree and I am sufficiently prepared to take care of patients."

When some in the audience said they weren't sure they'd actually use these kinds of steps in practice, one audience member offered her own approach to when a patient calls her "honey," which she said happens often. "I just say, 'I'm not honey, you can call me doctor,' and move on from there."

César said he thought the uptick in these bad behaviors might be coming from stress, especially from the COVID-19 pandemic, or even the news. "I think people are getting a lot of negative input into their lives, either directly or indirectly. And everything just feels like it's an additional stressor."

He expressed sympathy for what patients go through to get care, acknowledging how frustrating it can be for them. "You get there, you literally made 20 calls to make an appointment, you've talked to five different people, nobody's really understanding what it is that you need, and then you get into the room and you're dealing with a learner," César said. "And you're like, 'I've literally jumped through hoops and you gave me a student.' So I understand, and I try to put it in context."

Even so, he added, "when you let it slide, it does get worse." He recalled a patient who harassed one of his pharmacists, calling the pharmacist every day and eventually showing up to the clinic without appointments, and noted that some students had told him that they didn't want to do the work anymore after certain incidents with patients.

César said he looked forward to bringing the tools from the lecture back to Texas with him. "Not knowing how to deal with the situation could potentially be keeping great healthcare providers away from the profession."

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