For female psychiatrists specifically...

[sophiajoyDO09]

As I finish up my 2nd year as a medical student, I am still as certain as when I came that I will go into psychiatry. However, in the recent events in Virginia, and as I see the footage of the troubled young man who committed these heinous acts, ranting and raving about all sorts of things, I can't help but feel a little frightened. I worked as a psych tech for years before med school and have seen a variey of disorders, including some that were frightening. But I wasn't the one taking care of the patient directly. I worry that one day, when I am the psychiatrist, I may upset a borderline or an antisocial person, and what if I (or my family) pays the consequences?

I guess what I'm getting at is this...as young female in psychiatry, are you ever afraid? Are you afraid that a patient will follow you home, or hurt your spouse or child? The last thing I want is to feel paranoid leaving work late at night...feeling like I am being followed, or feeling afraid to be home alone! It's been on my mind a lot lately and would love to hear how other women feel and how they've handled various situations involving patients that just give you "that feeling." Thanks!

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[whopper]

You don't have to be a female to worry about this.

Don't have a family yet but I have a wife, and hopefully someday will have kids. What if your antisocial patient found your address and he/she hated you?

A friend's father who is a psychiatrist was accused of sexual assault by a borderline patient and he did not do anything of the sort to that patient. He was later found not guilty in court, but the case dragged for years and in the meantime his life was ruined.

1-don't list your phone number or address on registry that is open to the public
2-always practice some level of aloofness
3-always see problem patients with a chaperone present (another hospital employee)
4-always discuss with fellow staff any cases where you have reason to believe a patient can be dangerous or launch false accusations.

In general, even with the borderlines I feel safe when I practice the guidelines. So do my female colleagues. I've heard prison psychiatry though is a different ballgame. Don't know just how true this is if indeed it is and don't want to add to the rumor mill.

 

[lusyd]

I had a patient find my house once, and showed up threatening to hurt my family because of a billing mistake by the insurance company. It ended rather quickly secondary to me having a concealed carry permit, and the police arriving. Very scary stuff, and the advice above is very good.

 

[lusyd]

I had a patient find my house once, and showed up threatening to hurt my family because of a billing mistake by the insurance company. It ended rather quickly secondary to me having a concealed carry permit, and the police arriving. Very scary stuff, and the advice above is very good.

 

[lusyd]

I had a patient find my house once, and showed up threatening to hurt my family because of a billing mistake by the insurance company. It ended rather quickly secondary to me having a concealed carry permit, and the police arriving. Very scary stuff, and the advice above is very good.

 

[halflife]

I completely concur with whopper, and I am female. There's risks in this profession no matter who you are. There are also risks in many other professions - I have lawyer friends who deal in areas such as family law and criminal law who I would argue should potentially be more afraid than we should be. Not to mention the perils of being a pharmacist

Seriously, it's a cost-benefit thing for you to weigh up as to whether you want to deal with the sort of nagging fear that you seem to be holding around this (which I understand, but I feel it sort of comes with the territory in this field).

I don't think I can add any more to what's been said above, and Whopper gives some excellent tips. There's a lot of common sense involved.

The common sense every day sort of rules any woman should follow are also applicable here in terms of looking after one's personal safety. I'm pretty careful about how I leave work late at night, what way I walk to my car etc anyway - I don't think that would differ if I worked as an accountant instead, though.

You can only do the best you can to protect yourself...

 

[MeghanHF]

Agreed, this is a concern regardless of gender/sex. Here's a link to a related article published after the Fenton death in Sept:

http://www.psychiatrictimes.com/showArticle.jhtml?articleID=196902074

 

[Dartos Vader]

I don't think being female is a huge disadvantage in defending yourself in our field. I have a fairly extensive background in martial arts/wrestling/kickboxing/etc. But the thing is, most "attacks" are relatively easy to avoid/defend with techniques that can be learned easily. If someone takes you by surprise and hits you hard, man or woman, good fighter or not, you will get knocked on your butt. And for the patient who is in a full out manic state or acutely psychotic the only good "defense" is to pile on as many large individuals as you can, preferably one for each limb. Doesn't matter if you are a man or a woman, you aren't going to deter these individuals with pain alone. And guns (god forbid) work equally well on men or women.

And btw I heard somewhere that ER docs actually get attacked by patients more than psychiatrists. Don't know if this is true or not, but it doesn't sound too ludicrous.

 

[halflife]

Indeed, Go girl!!

I pack a 9mm myself.

 

[sophiajoyDO09]

I appreciate the comments. Thank you! And Whopper, good advice. I agree that you just have to be smart and pay attention to your surroundings, as with anything. I wasn't concerned with being "attacked" at work, as I know security and others are always available to help. Just more worried about being followed home, someone hurting my future spouse, or kids, etc. But again, those risks are there in any type of work I guess. I'll just have to start lifting some heavier weights at the gym over the next couple of years I just wanted to see if others had these concerns as well. I know I need to choose a specialty that will make me happy to go to work each day, and I have a feeling psych will be it. Thanks again.

 

[halflife]

I appreciate the comments. Thank you! And Whopper, good advice. I agree that you just have to be smart and pay attention to your surroundings, as with anything. I wasn't concerned with being "attacked" at work, as I know security and others are always available to help. Just more worried about being followed home, someone hurting my future spouse, or kids, etc. But again, those risks are there in any type of work I guess. I'll just have to start lifting some heavier weights at the gym over the next couple of years I just wanted to see if others had these concerns as well. I know I need to choose a specialty that will make me happy to go to work each day, and I have a feeling psych will be it. Thanks again.

Best of luck, I am sure you will be wonderful

 

[whopper]

I have had no reason to fear for my personal safety from the job outside the job.

While on the job, the involuntary ward can have risks but security is there in about 30 seconds--no exageration.

If you practice good safety guidelines by the time a patient can lay a hand on you--it'll take them more than that. I never felt in real danger on the unit--no more so than my college days when my fraternity brothers threw a lot of parties and at least 1 person a month got too rowdy.

The know of only 2 people who've been in danger because of the job, outside the job.

One was a resident in my program who got kicked out (not the one I mentioned in previous threads). In short, and she made a sexual advance to a patient who was known to be violent. She actually gave him her home address and they lived in the same complex...which was a run down place filled with people just above homeless living standards.

Idiot--what kind of person on a resident's salary would live there? Anyways the guy went to her place and beat the crap out of her.

As you can see, I don't think you'll have this problem. This was over the top x 3 level mistakes. Don't give your address, don't make a sexual advance on a pt (geez and to do on one a psychotic guy? how pathetic?!?!?!), and don't live in a complex where people get mugged almost on a daily basis!

The other problem was an attending I know told me that in prison psychiatry, there's a lot of corrupt guards, and they'll pull things like not come to your aid in time if you don't do certain things like prescribe xanax to patients-which these guards will then just take for themselves. HE told me his car ended up getting vandalized because he did not follow the guard's rules. I know I'm addiing to the gossip mill here but I've heard prison psychiatry can get like this from more than one doctor.

I've never felt in danger outside my job. I even once saw a patient who threatened to kill me at a local mall. When the guy made his threat he was psychotic. That was uncomfortable, but when we were in the mall, he was on meds and everytime I saw him afterwards he was very polite.

I would not let fear of safety deter you from this job. If my 5 foot mother can handle working in a long term forensic psychiatric hospital--you can too.

 

[jakesaw]

I had a patient find my house once, and showed up threatening to hurt my family because of a billing mistake by the insurance company. It ended rather quickly secondary to me having a concealed carry permit, and the police arriving. Very scary stuff, and the advice above is very good.

Re: a concealed weapon permit. I desire one myself for general protection. I live in a state that's law is "may carry"---which as I understand it means that you may be granted a concealed weapon permit if you can prove a need for such a permit (i.e. security guards, specific threats). Does anyone know if being a psychiatrist might be deemed sufficient cause? I'm wondering if stating for example that I work with psychotic patients would be deemed a sufficient need. Might anyone have any experience with this?

 

[tennreb]

I completely concur with whopper, and I am female. There's risks in this profession no matter who you are. There are also risks in many other professions - I have lawyer friends who deal in areas such as family law and criminal law who I would argue should potentially be more afraid than we should be. Not to mention the perils of being a pharmacist

There was a lawyer killed by his client here because he lost his divorce case. The guy shot him in the back as he was getting into his car in the parking garage, and he was only convicted of manslaughter and time already served. Good thing for him that nobody likes lawyers.

 

[MDhasbeen]

does anyone know what type of safeguards there are for those in, say, forensic psych, who work more frequently with criminally ill patients?

 

[xanthines]

I don't know where got his data from, but Dr Phil (Philip Resnick, that is) told my class one time that while psychiatrists may be the most likely specialists to be stalked by their patients, it's the plastic surgeons that are the most likely to be killed by their patients. Makes you think, huh?

-X

 

[Demosthenes]

Another thought, which might be frightening: do y'all know about zabasearch.com? It's scary -- I don't know where they get the records, but it seems as though it can find nearly anyone.

My advice is to try to keep all residential records in someone else's name if you're really worried. Spouse's name on the title of your house, or use your maiden name for the title if you use your married name.

Just my little ray of paranoiac sunshine, I guess, but the site has scared me, so I thought I'd make sure y'all knew about it, too.

 

[PsychMD2100]

Jakesaw and Halflife,

I wanted to ask you 2 more about the ethics of having a gun in, say, one's psychiatric office. Aside from the panic button, I wonder what your take is on having something more robust for personal protection inside of one's professional workplace.

Does anyone know if the APA has a position paper on this? Any idea if any state medical boards have weighed in on this?

I don't have strong feelings on either side. I'm simply thinking a couple years ahead when I'll probably have only a secretary, me, and my patient in my office. While I don't like to dwell on the thought of having to use a gun in my office, I do believe in legitimate self defense.

 

[whopper]

There are specific guidelines on self defense with regards to patients depending on the state.

IN NJ-where I am, to begin with, you shoot anyone, even is clear self defense, you're screwed. So I'm not too keen on having a gun while I'm here.

However in other states it may vary.

As to what you can do to protect yourself, that too seems to vary per state. In my program we do CPI training-which is basically a self defense class. However with regards to patients, there are also other guideilnes such as you can only match force for force. You cannot for example punch a patient if they're only threatening you. You can only match the force they give on about an equal level, and with the intent of self defense. I don't know how much this varies per state, but I have heard this is pretty much a general rule.

So when it comes to a gun, you pretty much won't be able to fire one unless fired upon, or a similar lifethreatening measure is taken against you. In terms of just brandishing it for defensive purposes, probably only if the situation were life threatening.

I however am not a legal expert on this so what I'm telling you is purely anectdotal and if anyone can find error in my post please mention it.

Another thing is from pretty much all the attendings I know, they haven't had any bad incidents so far with their patients. Most psychotic patients aren't high functioning enough to make a grudge work against you too much.

 

[jakesaw]

Another thought, which might be frightening: do y'all know about zabasearch.com? It's scary -- I don't know where they get the records, but it seems as though it can find nearly anyone.

My advice is to try to keep all residential records in someone else's name if you're really worried. Spouse's name on the title of your house, or use your maiden name for the title if you use your married name.

Just my little ray of paranoiac sunshine, I guess, but the site has scared me, so I thought I'd make sure y'all knew about it, too.

That is concerning (Zabasearch). What if you can't keep your records in someone else's name? As it stands anyone can type my name in on Zabasearch and find my address. Is there any way to stop this?

 

[Therapist4Chnge]

Re: a concealed weapon permit. I desire one myself for general protection. I live in a state that's law is "may carry"---which as I understand it means that you may be granted a concealed weapon permit if you can prove a need for such a permit (i.e. security guards, specific threats). Does anyone know if being a psychiatrist might be deemed sufficient cause? I'm wondering if stating for example that I work with psychotic patients would be deemed a sufficient need. Might anyone have any experience with this?

Great question....I'd like to get a permit eventually, though I'm curious how often it happens. From what I've read about "may carry" states....GOOD LUCK. I know there are a few states in the northeast that are "may carry", and they are next to impossible to get a permit.

IN NJ-where I am, to begin with, you shoot anyone, even is clear self defense, you're screwed. So I'm not too keen on having a gun while I'm here.

NJ has some horrid gun laws! I'm not a big NRA type person....but you are damned if you even think of 'self defense' in that state.

-t

 

[jakesaw]

Jakesaw and Halflife,

I wanted to ask you 2 more about the ethics of having a gun in, say, one's psychiatric office. Aside from the panic button, I wonder what your take is on having something more robust for personal protection inside of one's professional workplace.

Does anyone know if the APA has a position paper on this? Any idea if any state medical boards have weighed in on this?

I don't have strong feelings on either side. I'm simply thinking a couple years ahead when I'll probably have only a secretary, me, and my patient in my office. While I don't like to dwell on the thought of having to use a gun in my office, I do believe in legitimate self defense.

Hey PsychMD1200. I haven't really thought about protection in a private practice setting. Currently I would not even consider having a weapon on the job. I'm more concerned about when I leave work, psych patients or not. Perhaps something like a panic button and pepper spray may be appropriate in an office setting. Or it may be completely inappropriate and illegal--I don't know. I'd rather be in jail than dead or mamed, however. My primary concern, however, relates more to after hours.

 

[Therapist4Chnge]

Hey PsychMD1200. I haven't really thought about protection in a private practice setting. Currently I would not even consider having a weapon on the job. I'm more concerned about when I leave work, psych patients or not. Perhaps something like a panic button and pepper spray may be appropriate in an office setting. Or it may be completely inappropriate and illegal--I don't know. I'd rather be in jail than dead or mamed, however. My primary concern, however, relates more to after hours.

My standard response....I'd rather have a great defense attorney instead of a great mortician.

-t

 

[OldPsychDoc]

That is concerning (Zabasearch). What if you can't keep your records in someone else's name? As it stands anyone can type my name in on Zabasearch and find my address. Is there any way to stop this?

Nope--because like it or not, your DMV and real estate title records are public info. Look at it this way--if a psychopathic patient is REALLY determined to find you, they already have the means to by going to the courthouse and asking. The internet just allows them 24 hour access to this info.

 

[Therapist4Chnge]

Google + Boolean Terms + A bit of personal information = Dangerous Combination

-t

 

[jakesaw]

Nope--because like it or not, your DMV and real estate title records are public info. Look at it this way--if a psychopathic patient is REALLY determined to find you, they already have the means to by going to the courthouse and asking. The internet just allows them 24 hour access to this info.

While I don't disagree, I do think that the risk is increased substantially when the information is so much more easily accessed.

 

[Demosthenes]

In terms of just brandishing it for defensive purposes, probably only if the situation were life threatening.

Brandishing a gun is never a good idea: as soon as the gun appears, the situation has been escalated, and that gun is likely to be used. I know this from living in a rough neighborhood when in school. Never bring out a gun unless you are willing to use it -- AND willing to use it without too much thought.

Personally, I would have had no trouble shooting anyone who came through my door back then -- BUT I would have had to stop and think about the moral consequences of the act, and that thinking could easily have been fatal to me. Statistics show that guns are used against their owners far more often than they are in self-defense. (No, I'm not a fan of guns in the home or office, and I am in California.)

In that rough area of Oakland, California, I kept a weapon I felt safe with next to my bed: a fully charged fire extinguisher. I figured since it sucked air from a fire, a shot in the face should buy me enough time to get out -- and getting out is the goal, NOT getting revenge on the attacker.

And since I know that nothing I read on this board will change my views about this, and assume that the same it true of those of you who want to get guns for protection, let me make this simple plea: if you are bound and determined to get a gun for self-defense, please take a gun safety course at a reputable facility before doing so.

OK. I'll stop now.

 

[MDhasbeen]

Brandishing a gun is never a good idea: as soon as the gun appears, the situation has been escalated, and that gun is likely to be used. I know this from living in a rough neighborhood when in school. Never bring out a gun unless you are willing to use it -- AND willing to use it without too much thought.

Personally, I would have had no trouble shooting anyone who came through my door back then -- BUT I would have had to stop and think about the moral consequences of the act, and that thinking could easily have been fatal to me. Statistics show that guns are used against their owners far more often than they are in self-defense. (No, I'm not a fan of guns in the home or office, and I am in California.)

In that rough area of Oakland, California, I kept a weapon I felt safe with next to my bed: a fully charged fire extinguisher. I figured since it sucked air from a fire, a shot in the face should buy me enough time to get out -- and getting out is the goal, NOT getting revenge on the attacker.

And since I know that nothing I read on this board will change my views about this, and assume that the same it true of those of you who want to get guns for protection, let me make this simple plea: if you are bound and determined to get a gun for self-defense, please take a gun safety course at a reputable facility before doing so.

OK. I'll stop now.

excellent advice. i'm not sure how i'd handle taking a life, self defense or not. compared to a gun, i can't see how mace or a tazer etc would be any less effective in deterring an attacker.... pity i've never studied any defensive martial arts.

 

[PsychMD2100]

Does anyone know of any legal precedents or high-profile incidents of mental health professionals shooting patients in self defense? I'm trying to get as full of a picture of the issue as possible. Oftentimes, these examples illustrate some of the underlying concerns surrounding firearms in the workplace/home in the setting of mental health.

 

[whopper]

please take a gun safety course at a reputable facility before doing so.

Excellent advice, also get a lawyer to clearly define to you the legal implications.

I don't know of any legal cases where a doctor shot one of their patients. I'll have to look that up. Did a google search and didn't find any good articles among the several non-important hits that also showed up. (maybe overlooked them).

However, I have brought this issue up several times to attendings that I respect. All of them have told me the situation never got to the point where they had to fear their patients while at home.

Only doctor I knew of that was attacked by a patient at home was a resident in my program (was kicked out) that had several screws loose and made sexual advances on patients. She was dumb enough to give out her address to a psychotic patient hoping to land a date. To add to the idiocy, if you ever saw the guy, he looked like a stereotype mug-shot candidate and had a history to match.

That's not an indicator that our field is dangerous. Its an indicator that this resident was an idiot.

The only times they said the field was dangerous was on an involutary unit because patients can get out of hand, a crisis center (same problem) or in prison and this was due to politics with the guards. However in the first 2 so long as security is good there's nothing to fear so long as you practice good safety precautions.

 

[Dartos Vader]

Pepper spray or mace is a really good idea actually. I don't think there are many people in jail for spraying someone with mace. There is no permanent damage, and you are less likely to have a moral crisis about using when facing an assailant. Plus, if your kid finds it and gets into it, the results are much less tragic. And it has amazing stopping power. Remember that guy on TV "Dog the bounty hunter?" Apparently he often used that to apprehend "marks"? Eyes are incredibly sensitive. Spraying an attacker with pepper spray gives you the five minutes you need to get away, get safe and get help.

Once when I was in college, there was a riot and the police used tear gas on the rioters. The riot occurred right outside our dorm and we were sitting seven floors up watching the proceedings. The tear gas blew into our dorm! I can personally say that even that slight amount of exposure was intensely uncomfortable!