Patient violence calls for increased safety precautions.
PSYCHIATRIC VIEWS ON THE DAILY NEWS
As I mentioned in a column last Thursday, the homicidal gun violence has come to us in health care. Among the 4 shot and killed in Tulsa were 2 physicians.
One of them, his patient’s target, was Preston Phillips, MD, the orthopedic surgeon and section chief of the Warren Clinic. Besides his work in Tulsa, he did medical mission work in Africa.
We in psychiatry, of course, have some risk of physical violence from patients, especially if we are caring for the more severely ill. One of the most notorious examples was the killing of the well-known psychiatrist Wayne Fenton, who was beaten to death by his new patient in his private office on a Sunday in 2006.
Various recommendations came out of his death, as discussed by Richard Sherer in a January 1, 2007 article for Psychiatric Times™: “Violence Against Mental Health Professionals: Fenton Death Highlights Concerns.”1 Personally, I learned much about safety from my part-time work in a medium-security prison late in my clinical career.
Another colleague recently told me of his experience with inmate patient violence. The patient, with a history of violence, was apparently transferred to him from another prison, where he had just been taken off his antipsychotic. The attack included multiple blows to my colleague’s head and ensuring postconcussion symptoms.
These and other cases seem to call for such safety recommendations as:
1. Learn enough about possible patient risk in a new referral before agreeing to it.
2. The best predictor of patient violence is a history of violence.
3. Be very cautious about seeing any patient alone, especially on a weekend.
4. Have easy access to your door, phone, and buzzer for help, and leave your door open to begin with if feeling uneasy.
5. Keep in mind that patients who are paranoid are at higher risk for violence.
6. Be wary and prepare if there are escalating angry communications from a patient.
Given the increase in mass firearm murders, as well as other dangerous examples from health care settings, more safety precautions are needed for now. Do not be fooled by the claim that psychiatric patients are not more dangerous than the rest of the public. They are if not in treatment which is clearly helping. They are if they are paranoid, or having some active substance abuse. And there are always exceptions to such generalities. Do not let your professional narcissism get in the way of your personal safety.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.
1. Sherer RA. Violence against mental health professionals: Fenton death highlights concerns. Psychiatric Times. January 1, 2007. https://www.psychiatrictimes.com/view/violence-against-mental-health-professionals-fenton-death-highlights-concerns