Have you ever been assaulted by a patient?

[tehdude]

or do you have any close friends who have been? I'm curious just how common this is and how far patients usually take it. What sets these attacks off? Is it an unavoidable aspect of being a psychiatrist?

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[dl2dp2]

or do you have any close friends who have been? I'm curious just how common this is and how far patients usually take it. What sets these attacks off? Is it an unavoidable aspect of being a psychiatrist?

In the roughly 48 residents we have, I've never heard of a single assault. I would not say at all that it's unavoidable. In fact I'd say depending on the setting/patient mix, being assaulted is a rare event. In the context of outpatient psychotherapy, your risk of assault would be roughly equivalent to being a service oriented professional for roughly the same clientele--i.e. money manager or insurance salesman. It's likely much less than some other subspecialties of medicine such as ER.

 

[Apollyon]

Being a doc in the ED, I'll tell you that assaults (threatening behavior) and battery (actual contact) do occur. However, the only time I was ever battered was as an intern, off-service on OB/GYN (which was a hellacious rotation), by a pt with sickle cell, who somehow managed to become pregnant. She was sniffing ammonia in her room, and, when I went to confiscate it, she threw a one pound tub of hair gel at me, hitting me in the chest.

 

[whopper]

I've been assaulted. I wouldn't worry about it too much. These types of things do happen but they're not everyday, and if the institution you're at did their job, people will be able to react appropriately to this phenomenon, greatly decreasing the risk that staff members or patients will be harmed.

It's a type of thing where IMHO you do need training on it, you do need to follow proper guidelines, but once you do that, dont' lose any sleep over it, provided the institution is doing their end too. I've seen places that were not safe due to poor management.

 

[nitemagi]

I've seen it maybe every 2-3 years in my old program. Usually a brief event with few physical injuries if any. I agree with Whopper that your institution will have safety protocols in place. You will develop your own sixth-sense, too.

 

[whopper]

I agree with Whopper that your institution will have safety protocols in place.

Just remember that some places aren't safe. A particular hospital I know of had doctor's salary through the roof because it was not a safe work environment. The high salary was one of the only ways they could attract doctors.

 

[IAmAUser]

.

 

[nitemagi]

resident in my program just had a pt spit in her face in the er.
attending I worked with last year was punched in the face by an inpatient, demanding something schedule II I believe. attg was fine but did have a bruise for a week or so.
when looking at residencies it probably is reasonable to consider the availability / responsiveness of security staff at the institutions where you'll be working, depending on the typical pt population seen there.

Agreed. Be prudent, be safe. Healthcare providers with the highest risk of assault are ER nurses. Pay attention to the situation, history of violence, non-verbal communication, and basic safety precautions (exits, panic button). Talk with your security officer. Do test runs and check response time (good facilities will do this at least q6-12 mos). I've been in clinics where probably 75% of people wants benzo's or other controlled substances. I've been impressed with simple tools like a calm demeanor, not reacting to escalation with further escalation or pushing away, explanatory methods, and diffusing responsibility have helped "That's not available in our system. I see you're struggling. Let's talk about what i can offer."

 

[ShrunkenHeads]

Here's a good article I read on psychiatrictimes.com, titled "
Patient Violence Against Health Care Professionals"


http://www.psychiatrictimes.com/schizophrenia/content/article/10168/1813471

The annual rate of nonfatal violent crime for all occupations between 1993 and 1999 was 12.6 per 1000 workers.1 For physicians, the rate was 16.2. The rate for nurses was 21.9 (80% of nurses were subject to violent crime during their career). For psychiatrists, the rate was 68.2 per 1000. For custodial staff, the rate was 69 per 1000. The rate for other mental health workers was 40.7. Of psychiatrists responding to surveys, the average rate during their careers was 40%.
Surveys of psychiatric residents found an assault rate ranging from 19% to 64%; rates of repeated assaults ranged from 10% to 31%. The assault rate was 20% among surgical residents, and 16% to 40% among internal medicine residents. Compared with the nonfatal crime rate for all workers, health care professionals—especially mental health workers—are at heightened risk for becoming victims of violence.
CASES
The following cases are instructional. No blame is intended or implied. The facts in each case were obtained by Google search.
Wayne S. Fenton, MD, Psychiatrist
At age 53, Wayne S. Fenton, MD, was a nationally recognized expert on the treatment of schizophrenia. He was an associate director at the NIMH. In addition, he maintained a private practice and treated patients with severe mental illness on weekday evenings and on weekends. Dr Fenton was totally devoted to his patients.
On Saturday, September 2, 2006 (Labor Day weekend), Dr Fenton saw Vitali Davydov, aged 19, in consultation for treatment of severe psychosis. The father was present. On conclusion of the consultation, an appointment for treatment was made for later in the week.
On Sunday, September 3, the patient's father called Dr Fenton, pleading with him to see his son immediately. The son was agitated and angry about taking medications. At 4 pm, Dr Fenton saw the patient in a small, private office behind a locked door. The father left to run an errand.
Dr Fenton encouraged the patient to take an intramuscular long-acting antipsychotic. Upon the father's return, he found his son wandering about with blood on his hands. Dr Fenton was discovered beaten to death. The patient told police that he feared a sexual assault, among other fears.

 

[Therapist4Chnge]

I was assaulted once by a very disgruntled teenager. I had a few inches on her, but she had 20-30lb on me (btw, I'm 6'1 230lb). I think the lack of staff around was a major reason why she took the opportunity to lash out. I got out with only a scratch and a small bruise. I was definitely more aware of everyone around me after that incident.

 

[nitemagi]

Here's a good article I read on psychiatrictimes.com, titled "
Patient Violence Against Health Care Professionals"


http://www.psychiatrictimes.com/schizophrenia/content/article/10168/1813471

Good article, which reflects that a lot of violence in the context of psychosis (such as paranoia or delusions) is defensive by the patient. Don't corner them in a locked room. Don't see an agitated patient without security backup.

 

[tehdude]

Good article, which reflects that a lot of violence in the context of psychosis (such as paranoia or delusions) is defensive by the patient. Don't corner them in a locked room. Don't see an agitated patient without security backup.

How available is security in a private practice setting?

 

[nitemagi]

How available is security in a private practice setting?

Depends on your building.

 

[Sneezing]

Inpatient unit. In close proximity to MR young adult who was ticked off at the other resident. No contact made for either of us.

ED. On call and the patient didn't like the hospital/unit discharge that was arranged for. I was threatened and the patient took a swing at me. Police were already on seen and tackled the patient. I only had to take a step backwards and no strikes were landed.

 

[ShrunkenHeads]

Good article, which reflects that a lot of violence in the context of psychosis (such as paranoia or delusions) is defensive by the patient. Don't corner them in a locked room. Don't see an agitated patient without security backup.

Absolutely, but it seems even the best of us can be lulled into a false sense of safety over time, even a "nationally recognized expert on the treatment of schizophrenia". I wonder what his history as a psychiatrist was like, frequency of attacks (if there was any prior occurrence).

At the end of the day, one can never be too careful.

Maybe Frasier had it right all along!

 

[OldPsychDoc]

Intern, inpatient VA unit. Patient followed me into a dead-end room, stood in door and screamed at me. RNs and NAs quickly pulled him back.

Attending, inpatient unit. I left patient's room after telling her she was not being allowed to go home. She threw a plastic vase full of water at my head & missed.

Attending, inpatient unit. Petite but wiry manic female chased RN into my interview room (also a dead-end) blocking our exit and gave me "what for", wagging a finger in my face at extremely close range. 2 NAs were right behind her and pulled her off. One NA complimented me on my defensive stance, even though I've never taken any martial arts...

 

[nitemagi]

I got kicked in the shins once by an unruly 8 yo throwing a tantrum.

 

[ShrunkenHeads]

How often does one get a pt that tries to mess with your head?

I know it's something that's dramatized in movies, but I always wondered if this happens for real? I guess it's more likely to happen with someone who has APD.

 

[OldPsychDoc]

How often does one get a pt that tries to mess with your head?

I know it's something that's dramatized in movies, but I always wondered if this happens for real? I guess it's more likely to happen with someone who has APD.

If you expand the definition to include manipulative borderline splitting...then every fricking day.

If you mean Hannibal Lecter style questioning regarding which of us is truly insane...never.

 

[DrGoHuskies]

I've only had one really close call, at the end of PGY2, and it was a great reminder to expect the unexpected (and not get cocky):

Got called to the medical floor to consult on a 62 y/o woman with h/o "depression with psychotic features" and no previous hospitalizations, had worked full time all her life. Because I was underwhelmed by her physical presence and her history sounded fairly benign, I inadvertently allowed her to get between me and the exit, which she promptly blocked 20 minutes into the interview when she started to let her all paranoid delusions out. I was able to shimmy around her and into the (populated) hallway, where she proceeded to escalate and got in my face-- she had to be pulled away/redirected by some visiting family members. She ended up assaulting several nurses and a patient or two on the psychiatric unit over the course of her 2 month (!) stay.

Great lesson to never let your guard down. Not an experience I'll ever forget, because it was my own damn fault.

 

[Bartelby]

Does anyone know what counts as assault in these surveys (like the one referenced above)? I have seen 70 y/o demented patients swat at anyone who comes within arms reach (technically assault), but that is way different than, say, ending up stuck in a room for two minutes with a young and healthy patient doing their honest best to kill you. I wonder how often providers suffer an assault that leaves an injury which causes significant pain for >1 week or objective physical injury.

 

[zenman]

Intern, inpatient VA unit. Patient followed me into a dead-end room, stood in door and screamed at me. RNs and NAs quickly pulled him back.

Attending, inpatient unit. I left patient's room after telling her she was not being allowed to go home. She threw a plastic vase full of water at my head & missed.

Attending, inpatient unit. Petite but wiry manic female chased RN into my interview room (also a dead-end) blocking our exit and gave me "what for", wagging a finger in my face at extremely close range. 2 NAs were right behind her and pulled her off. One NA complimented me on my defensive stance, even though I've never taken any martial arts...

My Hapkido teacher said never adopt a defensive stance (or one which appeared like one) so the attacher would have no clue you knew any martial arts till they woke up in the ambulance on the way to the ER.

I'd be more worried about the more deadly assaults if working in a psych ER.

 

[Ibid]

One NA complimented me on my defensive stance, even though I've never taken any martial arts...

Ahhhh that will be you at 0.57 then....
[YOUTUBE]http://www.youtube.com/watch?v=67G7BeZkM_0&feature=related[/YOUTUBE]

 

[Mattchiavelli]

one of my psych attendings from med school got assaulted my 4th year. He worked in county which got a lot of the "patient is very agitated at a gas station" admits and work with people that had to be stabilized before they could transfer to prison. He did have the opinion that the patient should be closest to the door in an interview so they can not feel trapped, which was opposite what every other psychiatrist I worked with thought. With his patient population, I'm surprised it's that infrequent but there is very good support staff at that location.

There was an article in the journal Neurology about neurologists being at higher risk because of people with neurodegenerative disease that have trouble managing impulsivity and can get emotionally labile- I guess if you were doing a lot of geri psych that could be an issue too.

 

[DocThatRocks]

I was punched by a female patient. She usually would try to punch the attending but chose me that day. It did not hurt. I was pushed as I was leaving a patient's room. I was right behind the attending. A female patient who was intoxicated on 4 Lokos dug her nails into my hand and drew blood. This was after she was put into 4 point leathers and chemically restrained.


There have been really bad injuries from patients but it is mostly nursing staff that suffers horrible injuries. A nurse had her face broken in multiple places.

 

[DD214_DOC]

Delirious old guy with dementia tried to bite my arm, then tried to grab my crotch, but I was able to stop him. He did end up tearing a pocket on my white coat. It was myself and about 3 nurses who all were about 5'2 and weighed maybe 90 lbs. I learned I didn't take him seriously because he was an old frail guy.

This was while on medicine wards.

 

[Chimed]

Been attacked by a 16 yo while on the inpatient unit. Really, he was going after his Mom and I tried to stop him. He then turned on me. I didn't get hurt and just pushed him to the side.

 

[NontradJitsu]

I've been a long time lurker but this is the first time I've posted to anything here. I'm not a psychiatrist, resident or even med student. I work as a mental health specialist on an inpatient unit dealing mainly with psychosis and bipolar (although we do get our fair share of straight depression/axis II stuff) and I've seen a fair amount. I've personally been attacked twice in the year and a half I've been there, both from borderline pts. Once, they tried to grab my ID badge (thank God for the breakaway lanyard) and then tried to punch me in the face; the other time, the pt tried to throw a chair and then a laundry basket at another staff member and I intervened. Got an inch to inch and a half superficial laceration on my arm. I've been on the receiving end of a LOT of verbal threats though (which I honestly don't even count anymore because it's gotten so routine these days) and I've seen several physical assaults on other staff members including nurses being shoved/slapped and one other MHS being bitten on the arm by a pt with HIV.

Whether or not some or all of that could be avoided, I don't know, but I thought I'd add this account to kind of counter-balance those units that seem to be luckier than ours.