clozareal

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I don't know what the point of your post is. Every patient facing specialty has a risk of violence from patients, not just psychiatry. Bringing your anecdotal, misconceived "evidence of risk" to a new thread trying to claim causality does nothing but scare potential applicants over a risk that spans across every specialty in medicine, even dermatology.

Your post also perpetuates the stigma against mental illness, implying that those with mental illness are more likely to be violent. However, patients with mental illness are more likely to be the victims than the ones perpetrating violence.
 

ExcaliburPrime1

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I wonder if I could get funded for a study on the psychology of online trolling or the intriguing phenomenon of responding seriously to obvious trolls? I wonder what agency would be interested. :)
 
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WisNeuro

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*yawn* show me the per capita numbers compared to other professions. While I imagine mental health professionals may be higher than some other professions, you most likely need a lot of nuance to interpret any meaningful assumptions. The rates will differ wildly by setting and patient population. For example, I would assume that the rates of violence in those working with forensics would skew the data high. But yeah, this alarmist drivel, devoid of any meaningful discussion, is just tired news.
 
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Mad Jack

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splik

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I wonder if I could get funded for a study on the psychology of online trolling or the intriguing phenomenon of responding seriously to obvious trolls? I wonder what agency would be interested. :)
He's not a troll. The title is a bit click baitey but it is the internets after all. The fact is that psychiatrists in particular settings are at increased risk of violence compared with many other specialties (though EM is worse). While mental illness is neither necessary nor sufficient for violent behavior, substance abuse and personality disorder are strongly associated with violence and are common in our patient population. Add in certain mental disorders (TBI, PTSD, psychosis) and there is a cumulative increase in violence too. When you deal with committed patient, act as a custodian of the state, or refuse to prescribe opioids, benzos, and stimulants to patients, keep patients away from their children, don't agree someone is disabled etc then you absolutely put yourself at risk of violence. Psychiatry is a broad enough field that you can certainly choose to work in settings where the risk is lower (cash only psychotherapy based practice), but involuntary inpatient units, emergency departments, and community mental health centers certainly can be risky places to work. While scaremongering is inappropriate, to minimize the risks inherent with our patient population, the type of work that we do, and the settings we might work in is also a mistake.

And the whole "mentally ill are more likely to be victims rather than perpetrators" while true is irrelevant.
 

Crayola227

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I went to a lecture by a former police chief and current ED doc who became a leader in addressing healthcare workplace violence

the most violent practice location is the ED

don't go into EM if you're worried about injury
 

Mad Jack

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I went to a lecture by a former police chief and current ED doc who became a leader in addressing healthcare workplace violence

the most violent practice location is the ED

don't go into EM if you're worried about injury
I once had a co-worker that broke a patient's nose in self-defense in the ED. Also had a patient make a dive for a police officer's gun. And had a patient family member that was found bringing a pistol to the hospital as their loved one started to have a negative outcome. The number of people that threatened to kill us on the regular though, it was pretty common.
 
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MacDonaldTriad

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A delusional disorder somatic type patient shot 6 ER docs where I trained. Psychiatrists are most likely to be hit on adolescent inpatient units, followed by Geri inpatient. Honestly, we are an order of magnitude less likely to be hit compared to nurses. I think this is because of our patient's deep ability to utilize displacement and the incredible unconstitutional power we yield.
 
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Salpingo

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He's not a troll. The title is a bit click baitey but it is the internets after all. The fact is that psychiatrists in particular settings are at increased risk of violence compared with many other specialties (though EM is worse). While mental illness is neither necessary nor sufficient for violent behavior, substance abuse and personality disorder are strongly associated with violence and are common in our patient population. Add in certain mental disorders (TBI, PTSD, psychosis) and there is a cumulative increase in violence too. When you deal with committed patient, act as a custodian of the state, or refuse to prescribe opioids, benzos, and stimulants to patients, keep patients away from their children, don't agree someone is disabled etc then you absolutely put yourself at risk of violence. Psychiatry is a broad enough field that you can certainly choose to work in settings where the risk is lower (cash only psychotherapy based practice), but involuntary inpatient units, emergency departments, and community mental health centers certainly can be risky places to work. While scaremongering is inappropriate, to minimize the risks inherent with our patient population, the type of work that we do, and the settings we might work in is also a mistake.

And the whole "mentally ill are more likely to be victims rather than perpetrators" while true is irrelevant.
I think there's a difference between general workplace violence and what appears to be a cold and calculated murder (didn't bother clicking link from OP, but I'm reading between the lines).

Yes, anyone who works with dysregulated patients, ranging from the delirious to the intoxicated to the manic/psychotic is at risk of being assaulted (although that risk for physicians pales in comparison to the risk for nurses). But that's a different risk than what's being discussed here, and honestly most of the non-RN people I know who have been assaulted were men trying to act like heroes (myself included).

While psychotic/psychopathic murderers grab the headlines, I'm guessing it's too rare of an event to draw any real conclusions/correlations. To paraphrase a previous post, if you're making career decisions based on sensationalized stories, you're going to need to find a job where you can work from home behind several locks and outside of any hurricane/earthquake/tornado/zombie zone (maybe teleradiologist in Minnesota?)

Edit: The fact that mentally ill patients are more likely to be victims than perpetrators of violence IS relevant. It speaks against the idea that we have more antisocial patients in our patient population. Of course, you could argue that its flimsy evidence (for all I know, antisocial patients are more likely to be victims than perpetrators of violence as well), but its still worth mentioning in threads like this.
 
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psych md jd

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Speaking as a telepsychiatrist, I know that some day a patient will become violent and kill my video feed.
 

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Speaking as a telepsychiatrist, I know that some day a patient will become violent and kill my video feed.
A couple months ago I was asking a tele PTSD patient about his paranoia, and he responded by telling me that he still feels unsafe without his gun and carries it everywhere, then holds it up to the camera to show me.

my immediate response was thinking to myself "do you have any idea how much paperwork you've now caused me?"
 

psych md jd

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A couple months ago I was asking a tele PTSD patient about his paranoia, and he responded by telling me that he still feels unsafe without his gun and carries it everywhere, then holds it up to the camera to show me.

But being this is a .44 Magnum, the most powerful handgun in the world, and would blow your screen clean off, you've got to ask yourself one question: 'Do I feel lucky?' Well, do ya, punk?
 

PharmD500

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I went to a lecture by a former police chief and current ED doc who became a leader in addressing healthcare workplace violence

the most violent practice location is the ED

don't go into EM if you're worried about injury
Sometimes you'll even see videos of police officers dragging nurses out of the ED.
 

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I mean, my hospital had an "active shooter situation" during residency. Like most of them, it was a domestic incident that spilled over into work and an environmental services worker was killed by her ex boyfriend in the hospital hallway.

There are hazards to the job, but the real dangers are otherwise right in front of you.
 

Candidate2017

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Psychiatrists minimize the risk of homicide but it's real. There are studies out there you can look up. You cannot compare ER or hospital violence to psychiatry related violence because they are different situations. Psychiatrists are more likely to work in outpatient office settings where there is zero security compared to an ER, psych unit or hospital. Further not all violence are equal. An ER patient slapping a nurse or a geri psych patient punching an inpatient psychiatrist are not the same as a psychiatric patient showing up with a knife or gun to an outpatient office. Arguably the number of minor violent incidences in an ER gives staff and security an edge over your typical middle aged office manager in handling life threatening violence. That psychiatrist would've sustained fewer stab wounds in the ER and might have survived because a few beefy nurses would have jumped on the perpetrator instead of allowing him to chase the doctor into the alley and finish the job.
 
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I have never been in a fight out in the world. I have had multiple patients (the whole range of expected types: antisocial/substances, TBI/impulsive, and acutely manic) try to assault me. None of them were unexpected, but they all happened when many people would have said the patient was acting "calm" or "normal" immediately prior.

Sure, mentally ill as a whole may be of similar to the rest of the population in terms of violence, but that says nothing of the ED and inpatient population, who are definitely far more likely to be violent than the average person.
 
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PharmD500

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It's so sad! My heart goes out to his family. Things like this should never happen. I wonder if anyone called the police when the disturbance was still indoors. Why didn't the police get there before the guy had a chance to chase the doctor into the alley and kill him? Why didn't the office staff help?
 

northernpsy

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Psychiatrists minimize the risk of homicide but it's real. There are studies out there you can look up. You cannot compare ER or hospital violence to psychiatry related violence because they are different situations. Psychiatrists are more likely to work in outpatient office settings where there is zero security compared to an ER, psych unit or hospital. Further not all violence are equal. An ER patient slapping a nurse or a geri psych patient punching an inpatient psychiatrist are not the same as a psychiatric patient showing up with a knife or gun to an outpatient office. Arguably the number of minor violent incidences in an ER gives staff and security an edge over your typical middle aged office manager in handling life threatening violence. That psychiatrist would've sustained fewer stab wounds in the ER and might have survived because a few beefy nurses would have jumped on the perpetrator instead of allowing him to chase the doctor into the alley and finish the job.
Unfortunately, yes, I believe you are correct that there is published data indicating that psychiatrists are at increased risk of being killed by patients compared to most other specialties. Acknowledging that this is an occupational hazard allows us to prepare for it. I don't think it is enough of a risk that you should let it scare you away from the specialty. Just be aware that some of the patients you see do have the potential of violence and think about what you can do to reduce your risk in your particular situation.
 
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Mad Jack

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Just be aware that some of the patients you see do have the potential of violence and think about what you can do to reduce your risk in your particular situation.
Time for a service pitbull.

"Why do you need a service dog?"
"To relieve my anxiety about patients killing me."
 
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Candidate2017

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Unfortunately, yes, I believe you are correct that there is published data indicating that psychiatrists are at increased risk of being killed by patients compared to most other specialties. Acknowledging that this is an occupational hazard allows us to prepare for it. I don't think it is enough of a risk that you should let it scare you away from the specialty. Just be aware that some of the patients you see do have the potential of violence and think about what you can do to reduce your risk in your particular situation.
Violence risk can be reduced, homicide risk cannot. The risk of someone punching you because you didn't give them benzos or adderall can theoretically be reduced to zero... just give it to them! That's a joke sort of, but when was the last time anyone punched their FM doc, a.k.a benzo dealer? The risk of someone lying in wait for you in the parking lot because the voices told them you are Satan cannot be reduced, short of Invega Sustenna shotsfor everyone.

Once you admit the increased risk of homicide relative to other specialties, you need to admit there's really nothing you can do about it short of having a phalanx of Secret Service agents 24/7. Thus the defense mechanisms to deal with that elephant in the room. Denial, minimization, rationalization, humor.
 

thoffen

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What contributes to an increased individual risk of being a victim of violence or murder as a Psychiatrist? If we except the risk attributed to the population you serve, I have some intuitive ideas about it, but I'm not sure of the data.
 

birchswing

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Fall River, Mass., psychiatrist Claude Curran wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, ranking him behind only four other doctors, all from Puerto Rico. He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic … They tickle the brain in the same way alcohol does.”

Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own. “Anyone who’s ever had a panic attack is sympathetic to the use of the benzos,” Curran said. “Anyone who has never had a panic attack doesn’t understand it.”​

One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013 — ProPublica

If I could figure out how to look at that CMS data I could see what specialty those other four doctors are in. I did see a web-site once that listed top drugs prescribed by profession and various benzos were the highest for psychiatrists (and that data set is for drugs prescribed to Medicare patients--senior citizens, who are the most at risk of benzo complications), but I can't find that page now. It was part of ProPublica's site but now I can only find individual doctor reports.

As an aside, those quotes . . . He gives benzos to people trying to kick narcotics, when benzos are the hardest to kick . . . says they work well for panic attacks, when benzos take longer to kick in than a panic attack lasts. I'm guessing he uses benzos himself.

EDIT: This is the data, but I can't figure out how to work it:
Medicare Provider Utilization and Payment Data: 2015 Part D Prescriber | Data.CMS.gov
 

thoffen

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Fall River, Mass., psychiatrist Claude Curran wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, ranking him behind only four other doctors, all from Puerto Rico. He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic … They tickle the brain in the same way alcohol does.”

Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own. “Anyone who’s ever had a panic attack is sympathetic to the use of the benzos,” Curran said. “Anyone who has never had a panic attack doesn’t understand it.”​

One Nation, Under Sedation: Medicare Paid for Nearly 40 Million Tranquilizer Prescriptions in 2013 — ProPublica

If I could figure out how to look at that CMS data I could see what specialty those other four doctors are in. I did see a web-site once that listed top drugs prescribed by profession and various benzos were the highest for psychiatrists (and that data set is for drugs prescribed to Medicare patients--senior citizens, who are the most at risk of benzo complications), but I can't find that page now. It was part of ProPublica's site but now I can only find individual doctor reports.

As an aside, those quotes . . . He gives benzos to people trying to kick narcotics, when benzos are the hardest to kick . . . says they work well for panic attacks, when benzos take longer to kick in than a panic attack lasts. I'm guessing he uses benzos himself.

EDIT: This is the data, but I can't figure out how to work it:
Medicare Provider Utilization and Payment Data: 2015 Part D Prescriber | Data.CMS.gov
Wow. I hate how often people come my way and have anxiety/sleep/pain disorders with expectation of making them go away and no understanding of the disorder apart from the symptom. I try to get people to ally on treating the disorder as a priority.
 
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Wow. I hate how often people come my way and have anxiety/sleep/pain disorders with expectation of making them go away and no understanding of the disorder apart from the symptom. I try to get people to ally on treating the disorder as a priority.
That's just too much work. :p
Just give them a medication that both impacts the reward system and relieves the symptom and you can live on easy street. Of course, you might end up with the sleep difficulty if you have a conscience.
 

northernpsy

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Violence risk can be reduced, homicide risk cannot. The risk of someone punching you because you didn't give them benzos or adderall can theoretically be reduced to zero... just give it to them! That's a joke sort of, but when was the last time anyone punched their FM doc, a.k.a benzo dealer? The risk of someone lying in wait for you in the parking lot because the voices told them you are Satan cannot be reduced, short of Invega Sustenna shotsfor everyone.

Once you admit the increased risk of homicide relative to other specialties, you need to admit there's really nothing you can do about it short of having a phalanx of Secret Service agents 24/7. Thus the defense mechanisms to deal with that elephant in the room. Denial, minimization, rationalization, humor.
You can never totally eliminate the risk, but I think you can do things to reduce your odds of being victimized. For example, make sure you don't walk out to your car alone at the office. Schedule patients who could potentially be at higher risk of acting out at times when other people will be in the office to improve your chances of getting help if they do something. Make sure you take different routes to/from the office to make it harder for someone to stalk you, and vary your routine. Try to scrub as much of your personal info off of Google as you can. Keep your social media locked down and don't let your spouse or other family members post things about you that a stalker might be able to abuse. Some docs might feel comfortable carrying Pepper spray or a gun for self defense. Stay aware of your surroundings and make sure you always have a plan for escape if a patient escalates things.

These are just some ideas off the top of my head. Perhaps a forensic psychiatrist or someone who has been in private practice for a while might have other ideas on how to maintain safety consciousness.
 
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