A recent study by "Trend," commissioned by the Bulgarian Medical Union, reveals a troubling picture of workplace aggression in the country’s healthcare system. According to the survey, 56% of Bulgarian doctors have experienced verbal aggression, while 7% have been subjected to physical violence. Alarmingly, 41% of the public believe that in some situations, doctors are themselves to blame for such incidents.

Former Acting Minister of Health Dr. Miroslav Nenkov told journalists that these figures, while concerning, likely underestimate the real scope of the problem. “There is no doctor in the emergency department or ambulance service who hasn’t been verbally attacked,” he said, noting that verbal abuse in medical settings is a widespread, ongoing issue.

Dr. Nenkov identified a lack of communication training in medical education as a major contributing factor. “Patients arrive anxious, and we often lack the skills to calmly explain that a nosebleed is not more urgent than a heart attack. This is a significant gap in our training.” He also pointed to cultural factors dating back to the communist era, which perpetuate the belief that doctors owe their work to society unconditionally, rather than to their families or institutions.

When asked how Bulgaria compares to other European countries regarding aggression against medical staff, Dr. Nenkov responded, “It is much worse here. A frightened, anxious patient meeting an exhausted doctor creates a volatile situation that can quickly turn into aggression.” Survey respondents cited long wait times (57%), dissatisfaction with treatment (58%), and high healthcare costs as primary sources of frustration. Dr. Nenkov remarked that this reflects a cultural mindset: “We can pay 200 leva for a car oil change without issue, yet balk at paying extra for our own health, which is arguably our most valuable possession.”

Misuse of emergency services by uninsured patients was another concern. Dr. Nenkov compared Bulgaria to the UK, where ambulances transport patients only, and those deemed non-urgent are fined. He suggested that similar measures could help reduce unnecessary strain on the system.

The former minister also criticized legislative and systemic shortcomings. He said penalties for violence against medical staff are insufficiently enforced. “It is important for society to see that perpetrators receive meaningful sentences,” he noted. Regarding healthcare financing, he stressed, “The problem isn’t a lack of funds - it’s that a significant portion is stolen. If corruption were reduced, there would be sufficient resources for both patients and doctors.”

Dr. Nenkov highlighted unrealistic public expectations as another key issue. The survey found that 83% of people believe doctors must always make perfect decisions, and 80% expect them to be constantly available. “The myth of the Hippocratic Oath is often misunderstood,” he said. “It does not obligate doctors to work for free or beyond official hours. Many colleagues do so out of personal conviction, but it is not a formal duty.”