دانشگاه اصفهان پژوهش های راهبردی مسائل اجتماعی 3041-8623 15 3 2026 09 23 Contexts of Violence against Physicians in the Health System: A Grounded Theory Study in Ahvaz Medical Centers زمینه‌های خشونت علیه پزشکان در نظام سلامت: مطالعه‌ای داده‌بنیاد در مراکز درمانی اهواز 1 28 30131 10.22108/srspi.2025.146253.2143 FA زیبا دمادم دانشجوی دکتری گروه جامعه‌شناسی، دانشکدۀ علوم اجتماعی، دانشگاه یزد، یزد، ایران حسین افراسیابی استاد گروه جامعه‌شناسی، دانشکدۀ علوم اجتماعی، دانشگاه یزد، یزد، ایران Journal Article 2025 08 16 <strong>Introduction</strong> Violence against medical staff is a persistent and multifaceted challenge in contemporary healthcare systems. Its origins extend beyond individual behavior, rooted in broader social, cultural, and organizational structures. This phenomenon manifests in forms ranging from verbal aggression to physical assault with significant adverse consequences: it degrades the quality of medical services and patient satisfaction while severely impacting the psychological well-being and job motivation of healthcare workers. From a sociological perspective, violence in healthcare settings constitutes a social fact. It emerges from structural tensions, unequal power dynamics, unmet expectations, and the growing complexity of interactions between medical staff and patients or their companions. In recent years, this issue has intensified, gaining greater visibility through the rise of anti-physicianism—a social attitude marked by distrust, hostility, and a decline in the traditional symbolic respect afforded to medical professionals. Such attitudes contribute to escalating conflicts in clinical environments, complicating communication, decision-making, and the daily functioning of treatment teams. These outcomes ultimately weaken institutional performance and undermine public trust in the healthcare system. The primary goal of this research was to explore how medical staff perceive, interpret, and experience violence within hospitals and medical centers. By uncovering the underlying social dynamics, meanings, and behavioral patterns that shape such incidents, this study aimed to provide insights that can inform effective policy-making, targeted training programs, and significant organizational reforms.   <strong> </strong> <strong>Materials & Methods</strong> This study adopted a qualitative research design, utilizing a grounded theory approach to investigate the dynamics of violence and anti-physicianism within medical centers in Ahvaz. Data were collected through semi-structured interviews with 30 medical staff members from hospitals affiliated with Ahvaz University of Medical Sciences. Participants were selected via purposive sampling and interviews continued until theoretical saturation was achieved. The data analysis followed the systematic stages of grounded theory: open, axial, and selective coding. This analytical process revealed that violence against medical staff stemmed from the complex interplay of structural, cultural, and professional factors. These factors were conceptualized into 11 core categories: 1) normalization of violence; 2) eroding bureaucracy; 3) lack of resilience and empathy; 4) discursive contradiction; 5) transition from patriarchal to patient-centered medicine; 6) the absent doctor; 7) negative media representation; 8) medical distancing; 9) the distrust gap; 10) burnout; 11) the dilemma of leaving the profession or migrating. Together, these categories constituted the principal domains, through which the vicious cycle of anti-physicianism was reproduced.   <strong>Discussion of Results & Conclusion</strong> The interview findings demonstrated that violence against healthcare workers transcended individual or psychological explanations; it was fundamentally a manifestation of broader structural inequalities and institutional crises. This violence was sustained by an institutionalized culture embedded within wider societal norms and by dominant assumptions that normalized and justified aggression. Moreover, it was rooted in the specific social fabric of cultural regions, reflecting deep-seated systemic failures within both the healthcare system and society at large (Pavlova & Geretto, 2018). Effectively addressing this phenomenon necessitated comprehensive reforms in health policy. Key interventions included: Strengthening institutional and financial support for healthcare workers Promoting a positive and accurate public representation of their social status Criminalizing violence and developing effective legal deterrents Transitioning toward participatory, community-oriented models of doctor-patient interaction Implementing such strategies can cultivate social resilience and empathy, laying a foundation for reducing violence in clinical settings. Ultimately, violence against medical personnel is not merely an organizational or systemic dysfunction; it constitutes a profound semantic and symbolic crisis within the healthcare relationship. Responding to this complexity demands an integrated theoretical approach. This should incorporate Weber’s focus on the ethical intentions guiding actors; Derrida’s insights into the discursive hierarchies of modern medicine; Giddens’s structuration theory to understand how agents reproduce and transform systemic structures; and Parsonian principles to restore the normative balance in the doctor-patient role-set. Together, these perspectives illuminate the multilayered nature of violence in healthcare and can inform the design of significant, context-sensitive interventions. خشونت علیه کادر درمان یکی از چالش‌های نظام سلامت است که ریشه در ساختارهای اجتماعی، فرهنگی و سازمانی دارد. این پدیده بر کیفیت خدمات درمانی، رضایت بیماران و سلامت روانی کارکنان تأثیر منفی می‌گذارد. پژوهش حاضر با رویکرد کیفی و براساس روش داده‌بنیاد، با هدف فهم خشونت و پزشک‌ستیزی در مراکز درمانی شهر اهواز انجام شد. مشارکت‌کنندگان به‌روش نمونه‌گیری هدفمند انتخاب شدند و مصاحبه‌های نیمه‌ساختاریافته تا رسیدن به اشباع نظری ادامه یافت. درمجموع ۳۰ مصاحبه با کادر درمان بیمارستان‌های تابعۀ دانشگاه علوم پزشکی اهواز انجام و در سه مرحلۀ کدگذاری (باز، محوری و گزینشی) تحلیل شد<strong>.</strong> یافته‌ها نشان داد که خشونت علیه کادر درمان حاصل برهم‌کنش مجموعه‌ای از عوامل ساختاری، فرهنگی و حرفه‌ای است که در قالب 11 مقولۀ اصلی شناسایی شد: عادی‌پنداری خشونت، بوروکراسی فرساینده، ضعف تاب‌آوری و همدلی، تناقض گفتمانی، گذار از پزشکی پدرسالارانه به بیمارمحور، پزشک غایب، بازنمایی رسانه‌ای منفی، فاصله‌گذاری پزشکی، شکاف بی‌اعتمادی، فرسودگی شغلی و دوراهی ترک شغل/مهاجرت. این مقوله‌ها به‌عنوان مهم‌ترین زمینه‌های شکل‌گیری و بازتولید چرخۀ معیوب پزشک‌ستیزی شناسایی شد<strong>.</strong> براساس نتایج، مقابله با این پدیده نیازمند اصلاحات بنیادین در سیاست‌گذاری سلامت، حمایت نهادی و مالی از کادر درمان، بازنمایی مثبت جایگاه اجتماعی آنان، جرم‌انگاری و تدوین قوانین بازدارنده در قبال خشونت، و گذار به الگوهای مشارکتی و جامعه‌محور در روابط پزشک _ بیمار است. اتخاذ این اقدامات می‌تواند تاب‌آوری و همدلی اجتماعی را ارتقا ءدهد و زمینۀ کاهش خشونت در محیط‌های درمانی را فراهم کند<strong>.</strong> https://ssoss.ui.ac.ir/article_30131_40c334ed1463a9c44d0702cafe579ee6.pdf