Where else can you act this way?

[FLTDOC1]

"The art of medicine consists of amusing the patient while nature cures the disease" - Voltaire

( and just how well they are amused is reflected in your Press-Ganey scores)

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[docB]

While many patients have yelled at me, at one point or another, I only have had one patient throw something at me (?coffee mug)
I walked out right then & there, told my attending that I would not be seeing that patient anymore
Initially the attending said I had to, but I stuck to my guns & told her that putting up this crap is why people keep doing it
She ended up seeing the patient for the rest of her stay in the hospital
There are signs all over the VA stating verbal or physical abuse will not be tolerated so why put up with it in a community setting where you are more at rick since security is laxer?

I promise I'm not trying to be a jerk here so let me get this whole thought out before you get angry.

So you stuck to your guns but the only thing that happened was that your difficult patient had to be dealt with by someone else. Your attending had to step in. So the patient was an ass and as a reward they got an attending instead of a resident. Most asses would consider that a win for themselves. What will you do when you're the attending and there's no one you can punt the case to?

The fact is that it's not possible to not tolerate abuse in the majority of hospitals. The VA is free from EMTALA but the rest of us can't just toss people from the ED unless we're convinced they don't have an emergency or anything that could become an emergency. No matter how violent or evil they are someone will have to deal with them. In fact the more heinous they are the more the plaintiff's lawyer or the regulators will argue that it was obvious they were impaired, delirious, unsafe or otherwise in the throws of an emergent medical condition.

So it's not that we tolerate it and that's what perpetuates the problem. It's the legal and regulatory environment that created, fosters and basically makes inevitable the problems we face. Any time we put our foot down and fight the good fight (I do it sometimes too) it's just jousting a windmill until the structural causes get changed.