But the risks of treating the mentally ill are measurably greater than the risks facing other physicians or the American workforce as a whole. Times Online, a Web site combining reports from The Times and Sunday Times of London, reported that "the rate of [being a victim of] non-fatal, job-related violent crime is put at 12.6 per 1000 workers across all occupations in a survey by the US Department of Justice. Among doctors, the rate is 16.2 per 1000. For psychiatrists and mental health professionals, the rate is 68.2 per 1000."
Commenting on the Fenton case, the writer added, "Dr Fenton, 53, clearly had not foreseen that he was at serious risk. And if he couldn't predict it, who can?"
Paul Jay Fink, MD, past president of the APA and a consultant on youth violence and youth murder working with the city of Philadelphia, echoed the same thought in an interview with Psychiatric Times. "Can we actually determine who's going to be violent? We know that patients with untreated schizophrenia have more of a tendency toward violence, especially if they have been using alcohol(Drug information on alcohol). We know there are parameters to determine the possible level of dangerousness. Can we ever be 100% accurate? The answer is no."
Fink believes that a psychiatrist, especially one working with unstable patients, has an obligation to learn something about referrals if he or she can.
"When you have somebody who is dangerous and you don't know them and they don't know you, you need to be careful," he said. "Any little insult can fire up a paranoid patient, and that's a danger. The first thing a psychiatrist should learn is that he should get some information when he does the consultation, so he can get some sense of the presence of danger. You can get a message on your answering machine with no information and end up walking into a patient's gun, so to speak.
"Patients are impulsive," Fink added. "They can react negatively to a remark that you didn't think was terrible."
Inexperience—not a factor in the Fenton case—often leads physicians into difficulty, especially in dealing with mentally ill patients. Fink recalled an example from his own past.
"The uninitiated sometimes make big mistakes and say things they shouldn't say. I did once, 50 years ago, when I was a resident: I was in the residents' area and heard a noise in the day room. I went in and saw a patient of mine screaming and acting very psychotic. He was surrounded by 30 or 40 staff and other patients who were making things worse.