Long-suffering medic Juliet Alletson has been abused on countless occasions by frustrated, angry and alcohol-fuelled patients, she tells Health Correspondent Barry Nelson.

BEING kicked in the stomach by someone you are trying to help is bad enough. To be attacked in this way when you are heavily pregnant almost defies belief.

That is what happened to North-East accident and emergency doctor Juliet Alletson. And it has happened not once, but twice.

Fortunately, no serious damage was done to her unborn children who are now healthy youngsters, but the experienced A and E registrar from the James Cook University Hospital in Middlesbrough does not see why she - and other casualty unit staff - should put up with this kind of behaviour any longer.

Reacting to a British Medical Association survey of 3,000 UK doctors which found that violence is a problem in the workplace for almost half of respondents, Miss Alletson says: "People have to realise that, for whatever reason, they can't physically or verbally assault hospital staff. Whatever has happened to them it doesn't mean they have the right to assault doctors and nurses."

The long-suffering medic says she has been on the receiving end of verbal and physical abuse for years. Apart from being kicked, she has been punched, bitten and spat at, not to mention the more routine abuse of being jostled, pushed and shoved by angry or impatient members of the public.

"A lot of the people who come in are angry and upset for various reasons and this is often directed towards the staff," she says.

While doctors and nurses can sometimes see trouble brewing and defuse the situation, violence often explodes when everyone least expects it.

"A lot of the times I have been physically assaulted, it has come out of the blue," says Miss Alletson, who has worked all over the UK, including shifts in the last year at the University Hospital of North Durham and Sunderland Royal Hospital.

South Tees Hospitals NHS Trust point to falling rates of verbal and physical aggression directed against their staff.

But there were still 108 verbal assaults and 44 physical assaults recorded by the trust between April 1 and September 30 this year, and Miss Alletson argues that in a busy A and E unit, incidents are often not recorded.

While men appear more aggressive, women are just as likely to hit out as their male companions, she says.

Efforts to reduce waiting times will probably reduce incidents but Miss Alletson predicts this will not resolve all confrontations. "In fact, I would say very few of the incidents which result in violence are related to long waits for patients," she adds.

The registrar believes it is a small proportion of people who cause all of the problems and it is important to identify potential troublemakers early and get them off the premises.

"We have to reduce waiting times, get people in and out more quickly. Having a zero tolerance towards violence will help," she adds.

While security guards are not permanently situated in A and E at James Cook hospital - unlike some other North-East hospitals, including Newcastle General - Miss Alletson says security staff are quickly on hand if trouble breaks out. "Ultimately, violence is a problem of society," she says.

Consultant surgeon Peter Good, who works at Newcastle General Hospital's busy A and E department, agrees that it is the ills of society at large that hospitals have to deal with.

"In football, attitudes have changed, people who are violent are now regarded as hooligans and kicked out. We need to see that kind of change in attitude in our hospitals," says Mr Good, who was kicked in the chest a few weeks ago when he came to the defence of a nurse who was under attack.

"It was sore for a couple of hours. It's not the first time," he shrugs.

Drink-related violence is the main source of difficulty for Aand E staff at Newcastle, the consultant says. "Drink is a huge problem for us. We see the effects of drink all the time. It simply reflects society as a whole. This is reflected in the increasing number of drunken women seen in the unit."

Mr Good says that some people react badly to the environment they find themselves in, not helped by shock, drink or drugs.

Recently Newcastle General Hospital deployed A and E security guards and Mr Good says this has had a positive effect. But he worries that their powers are very limited.

The BMA believe hospitals must be better prepared to cope with violence, staff must have better training and, above all, the general public must get the message that lashing out at doctors is wrong, whatever the circumstances.