How (physically) safe is it to be a psychiatrist?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
P

PS2summerdays

CALI born and raised.
7+ Year Member
Joined
Mar 25, 2015
Messages
446
Reaction score
518
Most of the data I've seen is old and vague, but I've been hearing that psychiatrists are very likely to be physically assaulted/attacked on the job. Again, I'm not talking about verbal abuse (as that's common among all specialties lol) but literal punches, kicks, bites, stabs, projectile objects, etc.

Being physically assaulted as a psychiatrist would make sense, given the nature of some of the patients psychiatrists have to treat, especially in the ED and inpatient setting. But is it actually a common occurrence? Does anyone have any personal knowledge or experience with all this? Thanks all.
Members don't see this ad.
 
It does happen, but unfortunately it also happens in the med ER, in Urgent care settings, Jail and prison health care services.... Psychiatry may have some obvious risk, but we don't have a monopoly on getting hit.
 
MacDonaldTriad said:
It does happen, but unfortunately it also happens in the med ER, in Urgent care settings, Jail and prison health care services.... Psychiatry may have some obvious risk, but we don't have a monopoly on getting hit.
Click to expand...

Has it ever happened to you? Granted, I've only had limited experience in psychiatry, but I've never seen or experienced anyone getting assaulted. My parents are getting all worked up thinking I'm going to get murdered during residency if I apply to psychiatry. They have called 5 times today lol.
 
Members don't see this ad :)
Medscape: Medscape Access
It looks here like approximately 1 psychiatrist was killed by a patient during ~25 years. As far as assault there’s a wide range of meanings - if you mean a demented delirious 85 year old batting out at me I’ve been assaulted on several occasions. Incidents causing injury or requiring medical attention never. In medicine not psych, for me.
 
nebuchadnezzarII said:
Has it ever happened to you?
Click to expand...
Nope, I am a little larger than average and male, but I'm not sure that makes much difference. Even if you have guards and peace officers standing right next to you all the time, your best defense is an awareness of your surroundings and listening to your intuition about your patient's impulse control. I think nurses get hit more not only because they have more patient contact, but because doctors have more power over patient's fate and it is safer for patients to use displacement vs. hitting their doctor.
 
I have yet to be assaulted in any way in my roughly decade of experience. The 2 most dangerous events that I’ve seen/heard by close peers/faculty.

1 faculty friend was hugged by a large autistic adolescent while in a chair that leaned back. Both ended up on the ground after the chair flipped. I found this probably a bit too funny when I saw it.

1 psych peer was once slapped by an 80y/o woman for leaning in too closely to hear her. She misinterpreted his leaning to becoming too fresh with her.
 
I had one guy go from quiet and turned away from me to jumping out of bed, screaming and threatening to kill me (but intercepted by ED security as I ran out of the room.) I had just had a pleasant conversation with him a few hours earlier.

A manic patient tried to scoot closer and closer to me as I was trying to meet with her in the milieu (chosen because she was prone to violence already--she had punched an attending the day before; I had us sit on different couches for a reason) to deliver the news that she was committed. I saw it coming a mile away and kept myself at a distance and outran her when she finally lunged at me to try and hit me (and was then intercepted by mental health staff.)

A very concrete TBI patient was upset about something but seemed to calm down and offered to shake my hand, which I accepted, then he tried to squeeze my hand really hard (he was actually very strong but not strong enough that it was actually hurtful.) -- That was a learning experience, as a med student.

I'm overall very good at de-escalation but it's these sudden outbursts of violence that are the bigger risks. There was very little tell for the first one aside from a gut feeling. The second one I knew was risky which is why I took various precautions. The third one was a stupid lapse on my part.

I feel like there have been a coupe of other events but those are the ones I remember. I'm a tall dude FWIW, wasn't much of a deterrent.
 
FlowRate said:
A very concrete TBI patient was upset about something but seemed to calm down and offered to shake my hand, which I accepted, then he tried to squeeze my hand really hard (he was actually very strong but not strong enough that it was actually hurtful.) -- That was a learning experience, as a med student.

...The third one was a stupid lapse on my part.
Click to expand...

Maybe this is a stupid question, but why was it a lapse?
 
Members don't see this ad :)
In the 90's my program used to have a room in the ED nicknamed "the safe room" or something like that. Basically a padded room where they could place patients who were a risk to themselves until they were admitted to the unit. Apparently it used to be policy to have residents go in alone (with security right outside the door if the patient became violent) to get experience interviewing impulsive/high-risk patients. This ended after security didn't do a good enough job on the body search and a patient was able to keep a hidden knife on him in the room and stabbed a resident to death before security could intervene. The attending who told us this had also been stabbed by a patient who was actually looking for a different psychiatrist but stabbed him instead because she was manic.

There was a psychiatrist in Wichita who was killed by one of his patients at his outpt office a year or two ago and another in a Chicago suburb who was stabbed because she wouldn't prescribe a patient marijuana.

I've had a patient take a swing at me (antisocial pt on A LOT of PCP). I was actually calming him down a bit and then one of the other staff members started creeping up on him from the side and he started swinging. We had already called security, so he was subdued relatively easily (compared to what it could have been) but it could have been a lot worse.

So yes, the risk is definitely there. However, it's not nearly as common as your parents seem to be worried about and keeping a high level of awareness around the patients where it is warranted is typically enough to prevent these situations. An ounce of prevention...


Desired Member said:
Maybe this is a stupid question, but why was it a lapse?
Click to expand...

Allowing a very upset individual with a condition in which lack of impulse control is extremely common to grab your hand in a way that could potentially grant them physical control over you is a big no-no.
 
I have had two close calls, both in a Psych ED.

First one I was interviewing a gentleman who was extremely high risk for suicide but had very little interest in being hospitalized. He threatened to throw me through a window if I didn't let him go at that very instant, and he was big enough he could have made a go of it. I had made the mistake of sitting in such a way that I would have had to shift visibly in my chair to press the panic button on my lanyard and it was a small room where we were both equidistant from the door so I was not confident of my ability to get out before he could get to me. Thankfully my pokerface is pretty solid so I was able to seem calm while telling him that if he did that, he would still get admitted to the hospital. It looked like he was trying to decide for a minute but opted not to.

Second one I got rushed by an individual who was chronically psychotic but also pretty personality-disordered who was not pleased that we were a) not admitting him and b)contacting his ACT team. He was maybe five-six feet away from me, standing up, and closed the distance much faster than I thought possible with no warning; he was clearly not pleased before this but was not obviously posturing. I had just told him that we could offer him a dose of something to help him sleep while he waited for his team when he did it. My reflex reaction was to drop back into a ready stance and hold a clipboard up in front of my face in case he was planning to swing on me. He snatched the clipboard out of my hands and broke it over his knee before he noticed our large safety officers closing in and backed off. Again, pokerface, I repeated my offer and also told him we could make sure he got his normal evening medications as well and would he like a turkey sandwich?

Relevant:

The Last Psychiatrist: Bad At Math
 
From anecdotal experience it's more common than people usually say. There have been more than a handful of attendings/residents in my program who got physically hit or were very close to. Where I rotated as an intern in med school (a very well known west coast program), 3 nurses were bloodied in the space of 3 weeks in the psych ED.

I'm not writing this to scare people away but the risk is real. If you don't feel you can handle it, there are definitely ways to avert it. Telepsych, outpatient with high functioning population..etc.
 
Psychologist so....

1) the violence literature very clearly shows that substance abuse including marijuana are the most significant modifiable factor for physical aggression at an odds ratio of like 3+. Avoidance of this group is an easy way to reduce your risk.

2) The literature of residents being victims of physical violence is highly skewed in ED settings with psychiatry having a somewhat higher incidence than many specialities.

3) There’s a skill in deflecting. It’s not me that’s saying no; it’s the cdc. It’s not that I won’t help you in your child custody case, it’s that I am not competent to help you in that area. Beyond the normal professional literature, and educating yourself about what is and isn’t dangerous; the public relations book: When The Headline Is You is helpful.

4) I am extremely direct, and work in forensics. But only really assaulted three times. All were either diagnosed with MR or severe autism.
 
They should pass law assaulting doc = assaulting cop and results in severe prison time
 
Merely said:
They should pass law assaulting doc = assaulting cop and results in severe prison time
Click to expand...

Such a law would be untenable as there are just too many caveats. As many have mentioned, you'd be disproportionately jailing individuals with MR, severe ASD, severe TBI. Jail time would be onerously expensive and likely result in a worsening of these individuals' mental health, just making them more likely to lash out.
 
WisNeuro said:
Such a law would be untenable as there are just too many caveats. As many have mentioned, you'd be disproportionately jailing individuals with MR, severe ASD, severe TBI. Jail time would be onerously expensive and likely result in a worsening of these individuals' mental health, just making them more likely to lash out.
Click to expand...

Don't forget the public outcry when grandma becomes a felon when she decides that the doctor at her nursing home is stealing her things and takes her best shot.
 
Merely said:
They should pass law assaulting doc = assaulting cop and results in severe prison time
Click to expand...

Not realistic due to above reasons. That said, I have coordinated discharge from the ED with police for individuals with antisocial PD who did not meet criteria for admission and assaulted staff
 
Some close calls for sure, had some Attending’s thay were assaulted in the ED, also heard rumors of a resident that was killed in the state psychiatric facility years back.
 
Merely said:
They should pass law assaulting doc = assaulting cop and results in severe prison time
Click to expand...

This is a ridiculous proposition. Do you actually think this would deter psych patients from assaulting doctors?

It'd be more effective to have prison terms for mental health care providers who unnecessarily provoke patients into violence.
 
Last edited:
TexasPhysician said:
I have yet to be assaulted in any way in my roughly decade of experience. The 2 most dangerous events that I’ve seen/heard by close peers/faculty.

1 faculty friend was hugged by a large autistic adolescent while in a chair that leaned back. Both ended up on the ground after the chair flipped. I found this probably a bit too funny when I saw it.

1 psych peer was once slapped by an 80y/o woman for leaning in too closely to hear her. She misinterpreted his leaning to becoming too fresh with her.
Click to expand...
You haven't replied to my message :/ BUt you replied to this thread lol
 
Old&InTheWay said:
This is a ridiculous proposition. Do you actually think this would deter psych patients from assaulting doctors?

It'd be more effective to have prison terms for mental health care providers who unnecessarily provoke patients into violence.
Click to expand...

It’s not ridiculous. Someone just said it’s a law in a state already. I think the posters above have probably laid out why it’s not a good idea but it’s not ridiculous. If you think this is ridiculous you’re gonna be shocked everyday of your residency...
 
Merely said:
It’s not ridiculous. Someone just said it’s a law in a state already. I think the posters above have probably laid out why it’s not a good idea but it’s not ridiculous. If you think this is ridiculous you’re gonna be shocked everyday of your residency...
Click to expand...

I'm not sure exactly what exception you are taking with the word "ridiculous," but, as an idea, it is indeed absurd, reactionary, and unethical, and serves no purpose except to criminalize mental illness. Just because it exists as a law somewhere does not make it less absurd or more right. Again, do you really think the psychotic or intoxicated patient is going to alter their behavior based upon the number of years in prison they potentially face?

I've worked in places before med school where staff (myself included) were faced with potentially being assaulted pretty regularly. Deescalation, not punishment, is where it's at.
 
Old&InTheWay said:
I'm not sure exactly what exception you are taking with the word "ridiculous," but, as an idea, it is indeed absurd, reactionary, and unethical, and serves no purpose except to criminalize mental illness. Just because it exists as a law somewhere does not make it less absurd or more right. Again, do you really think the psychotic or intoxicated patient is going to alter their behavior based upon the number of years in prison they potentially face?

I've worked in places before med school where staff (myself included) were faced with potentially being assaulted pretty regularly. Deescalation, not punishment, is where it's at.
Click to expand...

Some mental illness should be criminalized
 
What i said had a fundamentally different meaning and implication. So, no. Its not "semantics."
 
erg923 said:
What i said had a fundamentally different meaning and implication. So, no. Its not "semantics."
Click to expand...

Nah bro mental illness is diagnosed through observing/reported behaviors so it’s pretty much same thing especially in practice
 
Merely said:
Nah bro mental illness is diagnosed through observing/reported behaviors so it’s pretty much same thing especially in practice
Click to expand...

You're losing me.

You want violence in a person with mental illness to be criminalized, right? Not their mental illness/disorder (e.g., schizophrenia, depression, substance abuse). Need to be careful here.
 
I don't see how it could be the same thing.

If a person had some disorder that made them have little empathy and yet they managed to live a life without hurting someone, they should die a hero and not a criminal. If a person has some paraphilia where they would hurt children or vulnerable people etc and they resist it, they should die a hero and not a criminal.
 
In my intern year, the only people so far who've thrown objects at me or punched their nurse have been my medicine patients. Or delirious old men.
 
You must log in or register to reply here.

Similar threads

redglare
“It’s Never Too Late”: A Memoir for Future Psychiatrists and Disillusioned Physicians
Replies
12
Views
1K
rjs2131
R
Psycho Bunny
To Psychiatrists- What is the financial future for the field?
2
Replies
54
Views
5K
psychmd03
P
B
How to be faster at H&P's as a resident
Replies
9
Views
1K
Orgone
Orgone
D
What's the best therapy modality for a practicing psychiatrist to get trained in?
Replies
35
Views
2K
LM02
L
P
How likely is it to make $375-400k in Psych?
3 4 5 6 7
Replies
300
Views
28K
MusicDOc124
MusicDOc124
Top