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Objective: To explore GPs' opinions about the causes of occupational violence in general practice., Design: A cross-sectional qualitative study., Setting: Three urban divisions of general practice in New South Wales, Australia., Participants: A total of 172 GPs: 18 GPs participated in focus group discussions and a further 154 provided written responses., Method: Purposive sampling was used to recruit GPs to participate in focus groups. Discussions were audiotaped and transcribed; each transcript was separately coded by all members of the research team. Focus groups were conducted until thematic saturation was achieved. Further qualitative data were obtained by offering GPs the opportunity, during completion of a written questionnaire sent to all GPs practising in the 3 urban divisions, to provide additional comments regarding their experiences and perceptions of violence. A modified grounded-theory approach, employing thematic analysis of the focus group transcripts and written responses from the questionnaires, was used., Main Findings: All focus group participants and 75% of questionnaire respondents had experienced episodes of violence during their general practice careers. Key themes that emerged in data analysis were used to construct a schema of participating GPs' perceptions of the causes of occupational violence. Elements in the schema include underlying causes, proximate causes, and GP vulnerability. Perhaps the most noteworthy findings within this structure were the emergent constructs--culture of fear, "naïve" practice culture, and GP vulnerability. To date these themes have not been evident in general practice literature on this topic., Conclusion: An understanding of GPs' perceptions regarding the causes of violence will be useful in planning general practice service provision and promoting GP safety.

Rationale, Aims and Objectives: Clinicians' means of stratification of risk of violence has been previously studied in health settings, but not in general practice. This study aimed to investigate the means by which general practitioners (GPs) assess risk of violence in their clinical practice., Method: A qualitative design using focus group interviews and written responses on a subsequent questionnaire. Focus group discussions were audiotaped and transcribed. Questionnaires were sent to all members of three Divisions of General Practice offering the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis. The setting was three Urban Divisions of General Practice in New South Wales, Australia. Participants were one hundred and seventy-two urban GPs - 18 participants in four focus groups and 154 GPs providing written responses., Results: Assessment and stratification of risk by GPs conformed to a schema based on the physical environment of the consultation, individual characteristics of the patient, individual characteristics of the doctor, and characteristics of the doctor-patient relationship. Despite this, risk assessment and risk stratification were often on the basis of ad hoc, subjective decision making. An aspect of the ad hoc nature of risk assessment was the pre-eminence afforded 'instinct' or 'intuition' in subjects' responses., Conclusion: A schema of factors involved in GPs' assessment of risk of violence is presented. An appreciation of these will be of clinical and policy importance.

Background: Violence directed towards GPs has been recognized as a significant problem in the UK. In Australian urban general practice, no study has previously examined this topic., Objective: The objective of this study was to investigate the responses of Australian urban GPs to experiences of violence and to perceptions of risk of violence., Design: A qualitative study of data collected from two sources-focus group discussions and qualitative questionnaire responses. Focus group discussions were audiotaped and transcribed. Questionnaires offered the opportunity for respondents to make qualitative comments. The focus group transcripts and qualitative questionnaire responses were coded independently by members of the research team and subjected to thematic analysis., Setting: Three urban Divisions of General Practice in New South Wales, Australia., Subjects: Focus groups were conducted with male and female GPs comprising a range of ages, socio-economic practice catchments and practice structures. Questionnaires were distributed to all GPs in the three divisions., Results: The GPs in this study perceived themselves as being at significant risk of occupational violence. Despite responses to violence being largely ad hoc and uncoordinated, a coherent schema of GPs' responses to the threat of violence is apparent in the data. This has been characterized as encompassing primary, secondary and tertiary responses, and reflects a continuum of proactive to reactive responses., Conclusion: The findings will have implications for further research and for policy in the area.

Background: Workplace violence in general practice has been found to be an important problem in the United Kingdom. No research has been undertaken in this area in Australian urban practice., Method: Four focus groups involved 18 urban general practitioners and over 9 hours of taped responses were transcribed. The transcripts were coded and subjected to thematic analysis., Results: General practitioners expressed a wide range of risks relating to the provision of after hours care. This makes them apprehensive about participating in it. Those who had experienced violence, or perceived its risk, had limited their participation in after hours care; sometimes completely., Discussion: Structures may be needed to support provision of after hours general practice services.