Is psychiatry a safe field?

[MellowYellowCA]

This may sound like a silly question, but how safe is it to be a psychiatrist? After residency, I assume I can screen patients. But before that point, I plan to get pregnant and have children during residency. I get worried because my friend (a PGY4) told me a patient of hers at a community clinic pushed her to the floor and kicked her. I wouldn't want something like this to happen to me while I am pregnant. Thoughts? Thanks!

---

Members don't see this ad.

 

[peppy]

The reality is that psychiatrists are at a higher risk of assault than many other specialties. I have met psychiatrists who have been punched by patients. A few years ago there was a case in the news of a schizophrenia expert who was murdered by a psychotic patient.
However I would not avoid the specialty based on this risk. If you are conscious of safety you can protect yourself in various ways (things like making sure you are always closer to the door than the patient, knowing where the panic button is in the interview room, asking other staff to accompany you when you talk to patients who seem volatile, etc.) You can also ask at interviews about what kind of safety measures are available for residents at the various programs.
There are hazards in many fields. Surgeons and EM docs are at higher risk of needlesticks (and EM docs also deal with a lot of volatile patients). Radiologists and interventionalists are at risk from radiation exposure. IM docs can get assaulted by demented patients or could be exposed to infectious disease.

 

[loveboatdoc]

Even though I had a "panic button" (it looked like a garage door opener), and even though I was closest to the door, a guy changed on me very fast and went from seeming pretty docile to jumping me. I set off the alarm, but it took a while for help to arrive. I'm OK, but this incident didn't exactly turn me on to psych. I got a little beaten up, but no permanent damage done except to be afraid of that dude!

Also, the psychiatrists had to park in odd spots, far away from the facility...there seemed to be a lot of slashed tires on doctor's cars.

Aren't we in a fun profession...medicine...deciding which field is semi-safe? Risks exist in every area, it seems.

I've said this before...BUY DISABILITY Insurance! (I know 2 colleagues who contracted career-limiting diseases from pts...protect yourself)

 

[MyGenome]

-

 

[jettavr6]

Using common sense, the likelihood of being hit by a patient is relatively low. Regardless, it's a risk that comes with fields such as ER, IM, Pain and Psych. As an ER doc, I think you are at a substantially higher risk than any other field. I have seen internists get hit by patients who were delirious or demented. When dealing with a poplation of patients who are drug seeking, they can become violent if not given prescriptions that they want - This puts both pain and psych patients at risk. The risks are self explanatory for psychiatry.

More than anything, these days I believe that the societal views towards physicians in general have changed. All physicians are subject to the risk of violence in the workplace, more so than in previous years.

 

[peppy]

Are residency programs likely to accommodate or take into account safety issues for a pregnant female?

I guess the biggest risk is when seeing psychotic patients. Should I try to avoid seeing psychotic patients when I am pregnant?

Are some programs safer than others?

Generally, programs don't want residents to be injured even if they aren't pregnant, so I would expect that most programs are already doing their best to protect residents. However, I'm sure there are variations in how many volatile patients various psych programs see, and different rotation sites can have different feels to them in terms of the level of patient acuity and level of awareness of safety. In some ways seeing the more acute/volatile patients as a resident may be a good thing - better to learn how to handle aggressive or volatile patients as a resident than as an attending. If you're very concerned, it might be worthwhile to ask the residents at interviews how they feel about the safety precautions at their different rotation sites and see what kind of feel you get for things on tours.

There is a lot of literature about the risk of violence among psychiatric patients. Take a look at what the literature says about the relative risks from different diagnoses if this is an issue that really concerns you.
Personally, I don't find psychotic patients to necessarily be scary. I have met some very pleasant and friendly patients who were also extremely psychotic. Personally, the only diagnosis I have found to be highly correlated with my feeling uncomfortable with patients has been antisocial personality disorder.

 

[MellowYellowCA]

I've said this before...BUY DISABILITY Insurance! (I know 2 colleagues who contracted career-limiting diseases from pts...protect yourself)

What specialty was your friend?

 

[MellowYellowCA]

In some ways seeing the more acute/volatile patients as a resident may be a good thing - better to learn how to handle aggressive or volatile patients as a resident than as an attending.

I agree, just don't think I would want to have this practice whilst being pregnant.

What types of precautions may some programs take that others may not?

What types of programs are more likely to see dangerous patients - any difference among university programs, community hospital, etc?

 

[J ROD]

What happens if you beat the patient down if they attacked you....do you get in trouble for beating down the patient or is it considered self defense..

 

[markglt]

touch a patient....you're outta there

 

[Doctor Bagel]

Generally, programs don't want residents to be injured even if they aren't pregnant, so I would expect that most programs are already doing their best to protect residents. However, I'm sure there are variations in how many volatile patients various psych programs see, and different rotation sites can have different feels to them in terms of the level of patient acuity and level of awareness of safety. In some ways seeing the more acute/volatile patients as a resident may be a good thing - better to learn how to handle aggressive or volatile patients as a resident than as an attending. If you're very concerned, it might be worthwhile to ask the residents at interviews how they feel about the safety precautions at their different rotation sites and see what kind of feel you get for things on tours.

There is a lot of literature about the risk of violence among psychiatric patients. Take a look at what the literature says about the relative risks from different diagnoses if this is an issue that really concerns you.
Personally, I don't find psychotic patients to necessarily be scary. I have met some very pleasant and friendly patients who were also extremely psychotic. Personally, the only diagnosis I have found to be highly correlated with my feeling uncomfortable with patients has been antisocial personality disorder.

I'd say Cluster B patients in general are the scary ones, namely narcissists, APD and BPD folks. Psychotics not so much.

As for safety, my general take is you've got to be mindful of protecting yourself. The program and the structure of the unit can only do so much. If you get all macho and go into situations that are dangerous, bad things might happen. Personally I'm not going to go into a small interview room with someone who scares me -- instead, I'll talk with them somewhere more in the open. I also don't talk to people who I deem to be scary alone, and yeah, always do the thing where I'm closer to the door than the patient. In addition, I have a low threshold for calling security or the police (they're real cops at the VA and get a little touchy if you refer to them as security) if needed. And if someone is being really agitated and won't calm down, I leave the situation. Another biggie -- if someone doesn't want to talk to you, don't push it.

 

[Manicsleep]

touch a patient....you're outta there

Depends on the situation.

If it really is self defense, then your safety is your safety. Of course, the best thing to do is not to put yourself in the position where you can be harmed. That may seem easier said that done but it can be done.

I've seen a patient get taken down more than once by staff while awaiting involuntary medication orders from the courts. Just make sure you document what happened. There are forensic hospitals in California where this happens on a daily basis.

 

[Manicsleep]

I always look for a few things in violent patients. Schizophrenia is usually not one of them unless there are strong paranoid/persecutory delusions regarding the current or previous staff.

Here are 5.

1) PVs hx of violence
2) Alcohol/Drugs
3) ASPD/Psychopathy and to a lesser extent other cluster Bs
4) Mania/mixed/agitated depression
5) MR/TBI/other brain injury

 

[MellowYellowCA]

I'd say Cluster B patients in general are the scary ones, namely narcissists, APD and BPD folks. Psychotics not so much.

How often will you see a Cluster B patient in four years of residency?

 

[OldPsychDoc]

How often will you see a Cluster B patient in four years of residency?

Everyday that you're not doing inpatient neurology tending intubated coma patients.

 

[erg923]

touch a patient....you're outta there

Not where I'm from! In undergrad I worked at a state hospital and one of the psychologists was a former linebacker and a personal trainer. He was typically the biggest guy on the Unit. I saw him "take down" agitated/violent patients on several occasions with little assistance.

In my current training I have also heard of an inpatient psychiatrist who blocked a punch and held the patient's arm behind his back in a defensive hold (to prevent further punches from being attempted) until other staff arrived. All this said, "beating up" patients or participating in a fulls scale fight or brawl with them is not acceptable. However, I see no reason to play MLK when it comes to my safety with patients.

 

[billypilgrim37]

Everyday that you're not doing inpatient neurology tending intubated coma patients.

Are all the NICU nurses on vacation?

 

[Manicsleep]

Are all the NICU nurses on vacation?

You beat me to it.

MellowYellow. Its really not that bad. You have to realize that mentally ill patients are everywhere. PCPs see cluster Bs every day too, they just arent as well prepared to deal with them as we are.

Don't want violent patients at all? Go into pathology.

 

[OldPsychDoc]

Don't want violent patients at all? Go into pathology.

Zombies!

 

[Faebinder]

I'd say Cluster B patients in general are the scary ones, namely narcissists, APD and BPD folks. Psychotics not so much.

***********

Another biggie -- if someone doesn't want to talk to you, don't push it.

Probably the best and most protective two points. Psychiatry comes with risks but that's why we are in demand, cause no one wants to put themselves at this minor risk.

 

[notdeadyet]

Psychiatry comes with risks but that's why we are in demand, cause no one wants to put themselves at this minor risk.

More likely folks are scared off by the focus on mental health instead of physical health.

I'd love to think that there's a big demand for psych because folks are scared off by the danger factor, though. Counter to image, I like the image of the psychiatrist as toughies of the hospital staff.

"Scraping a match off the bottom of his motorcycle boot, the psychiatrist cups a hand and lights his hand-rolled. 'And how does that make you feel?' he growls..."

 

[OldPsychDoc]

More likely folks are scared off by the focus on mental health instead of physical health.

I'd love to think that there's a big demand for psych because folks are scared off by the danger factor, though. Counter to image, I like the image of the psychiatrist as toughies of the hospital staff.

"Scraping a match off the bottom of his motorcycle boot, the psychiatrist cups a hand and lights his hand-rolled. 'And how does that make you feel?' he growls..."

"Go ahead...make my day..."

 

[kugel]

Is psychiatry a safe field?

No.
But it's probably safer than driving to/from work each day.
Almost no chance of cuts or needle sticks.
Very few lifting/moving injuries (unless you're often involved in implementing seclusion/restraint).
Patients are searched before getting into our emergency room.
Staff can and WILL do what's necessary to defend me.

My biggest risk is "involuntary discharges" of pt's demanding shelter in the hospital.
Looks like I picked the wrong week to quit letting in everyone who says the word "suicide."


http://www.youtube.com/watch?v=lyhaTQseKTQ

 

[bunx]

This may sound like a silly question, but how safe is it to be a psychiatrist? After residency, I assume I can screen patients. But before that point, I plan to get pregnant and have children during residency. I get worried because my friend (a PGY4) told me a patient of hers at a community clinic pushed her to the floor and kicked her. I wouldn't want something like this to happen to me while I am pregnant. Thoughts? Thanks![/QUOTE

I think this is a good question and one of the concerns I had when going into psychiatry myself. It's important to learn how to do a good risk assessment, know when to trust your gut, and also learn techniques for how to diffuse a tense situation (or when to walk away from one). I've been fortunate to not have any problems and have actively sought out teaching on how to safely manage agitated patients so I feel more confident in this area. And though psychiatry may have a higher rate of assault, I definitely know plenty of ED and medicine docs who have been hit by patients. As an aside, I'm pregnant, a resident, and work in a psych ED and haven't had any problems. But I am also cautious with pts I don't know and always like to have a nurse or security person nearby if I think someone is an assault risk.

 

[MellowYellowCA]

Thank you for the replies, everyone. They were helpful. I asked this in another place but the thread isn't active, so I will ask again here. Is it true that in some residencies programs you are less likely to see soem types of patients vs others, depending on the type of setting university vs community, and the location, lower income vs higher income? How does this relate to safety in the program? I plan to go into child psych, by the way

 

[Psychiatrypd]

Yup. Some residency programs have many severely and chronically mentally ill paitents and some focus more on psychotherapy with more stable patients. You have to decide what the most important job criteria are to you. If safety is #1, then do pathology. Definitely do not do plastic surgery as they are more likely than other specialties to get killed by their patients. In our area, a revered ENT surgeon was shot to death by an elderly patient and no one knew the patient was psychotic before the patient murdered his physician. Murder of physicians is quite rare. If you like psychiatry for other reasons, you can learn some self-defense techniques that are quite helpful. child psych is a wonderful field. Those autistic kids will sometimes spit on you or hit you - they are sometimes really scared of you. But you will survive. Helping people feel better and live fuller lives is an awesome thing and I think it is worth the occasional blow.

 

[EMDO2018]

In our state hospital last year there was a nurse who was shanked by a patient who broke a piece of hard plastic off of one of the beds and sharpened it into a dagger.

 

[TexasPhysician]

My fellow residents had a competition that started PGY-1: Who would be the last to be assaulted?

66% of us were never assaulted in the 4 years. I was hit by a developmental patient and barely felt it. The most severe of assaults involved a 75 year old woman on inpatient slapping a resident across the face. He couldn't hear her and leaned in. She was apparently telling him to go away.

 

[whopper]

I don't see psychiatry being worse than say an ER doctor that has to deal with patients coming in on PCP that are violent. As mentioned above there are dangers in every field of medicine. You work in infectious disease, you will likely see TB-infected patients, you do surgery-you could accidently knick yourself with a scalpel that touched a patient, etc. PCPs are the nation's largest psychiatric providers because the majority of people ask their PCP for help before they consider a psychiatrist.

I've seen some psychiatric institutions not be safe, but these are not the norms of practice and an attending could easily choose not to work at such a location and have a wide array of other options.

I was working in the local jail yesterday and was seeing a guy naked, jumping up and down on his bed, and I talked to him through a door about 4 inches thick made of steel with a plexiglass window. The guy was faking all of it. I did not see any danger whatsoever to me.

What was going on was he was fine for days. Then he saw an attractive female inmate transferred to the psych infirmary and wanted a cell next to her so he could flirt with her, so he pretended to be what he thought was insane to be sent up there with her.

For the bookworm who hasn't had much social experience in these matters, such a situation could make one scared. I'd be more scared to go into a room with a treatment resistant TB patient.

 

[Doctor Bagel]

My fellow residents had a competition that started PGY-1: Who would be the last to be assaulted?

66% of us were never assaulted in the 4 years. I was hit by a developmental patient and barely felt it. The most severe of assaults involved a 75 year old woman on inpatient slapping a resident across the face. He couldn't hear her and leaned in. She was apparently telling him to go away.

Wow, I don't know of any of my classmates who got assaulted during our 4 years of training.

 

[Nasrudin]

. Leaning in to hear the old lady and them getting slapped is pretty hilarious though.

I agree with whopper. I tested positive for TB after working in the ER. I've gotten a needle stick there and now on medicine. Surgeons are at a huge risk for hepC. Psych doesn't scare me at all. Individuals might. But not the field.

 

[whopper]

I got punched once and it was something on my end that was a green mistake and could've been avoided. I had an anti-social gang-banger sociopath suffering from an acute bout of anxiety from her hallucinations. I was seeing her for the first time because I was just transferred to that forensic unit and all the patients were new. She was in severe distress so to show some empathy I came in close enough to be sucker punched. I could've just interviewed her a few more feet away.

 

[Shikima]

One resident I knew got sucker punched in the back of the head by a psychotic antisocial. I've been spit on and had swings taken at me by other psychotic antisocials. There have been some scary times of guys coming in under the influence of illicit substances, but eventually put down with Thorazine.

 

[F0nzie]

I was flipped off and kicked in the shin by a 6 year old as soon as I walked into the examination room.

I have been postured at and chased around the clinic. Recently had a box of kleenex thrown at me. Dodged it.

 

[digitlnoize]

Psychiatry is actually pretty safe. There was a study on this a while back, but I don't have time to find it. The most dangerous fields (most likely to be assaulted) were as follows (as I recall):

1. ER
2. Geri
3. IM (because of Geri)
4. Psych
5. OBGYN

I think. We were pretty far down the list. I've never been attacked. I had one classmate who had a patient take a swing at her. Otherwise, no issues.

 

[BobbyB]

touch a patient....you're outta there

i worked in a psych ward and have KO'd a patient. i was ordered to retake my restraining patients seminar and was banned from working the child and adolescent wing.

 

[Shikima]

i worked in a psych ward and have KO'd a patient. i was ordered to retake my restraining patients seminar and was banned from working the child and adolescent wing.

Derp.

 

[Shikima]

I was flipped off and kicked in the shin by a 6 year old as soon as I walked into the examination room.

I have been postured at and chased around the clinic. Recently had a box of kleenex thrown at me. Dodged it.

I bet you used Neo's moves dodging that box....

 

[jettavr6]

Psychiatry is actually pretty safe. There was a study on this a while back, but I don't have time to find it. The most dangerous fields (most likely to be assaulted) were as follows (as I recall):

1. ER
2. Geri
3. IM (because of Geri)
4. Psych
5. OBGYN

I think. We were pretty far down the list. I've never been attacked. I had one classmate who had a patient take a swing at her. Otherwise, no issues.

Interesting - I wouldn't have expected Ob/Gyn on the list. ER certainly is very dangerous. I'm hearing that urgent care centers, whoever they are owned by, are having issues with violence. Pain practices can be dangerous depending on the payor population.

 

[wolfvgang22]

Interesting - I wouldn't have expected Ob/Gyn on the list. ER certainly is very dangerous. I'm hearing that urgent care centers, whoever they are owned by, are having issues with violence. Pain practices can be dangerous depending on the payor population.

Have you ever met a woman in labor??

Just kidding, of course you have. I couldn't resist.

 

[whopper]

ERs in poor urban downtown areas are like MASH units in a battlezone. I worked in an ER in Newark while a medstudent. People came in with stab wounds, bullet wounds, being beaten up and this type of thing wasn't happening on the opposite side of town but just a block or two away. Same hospital had a car a month stolen from it's parking lot despite sharp-wired fencing and armed security guards around it and you couldn't even walk from the parking lot to the hospital without a guard or in a vehicle driven by security because a doctor about once a week was viciously assaulted before they made this mandatory policy.

These were non-psychiatric docs.

A hospital a few blocks away had women coming in in labor with their 5th (or 6th, etc) child while on crack-cocaine and heroin and the child was premature because the mother was high at the time. Then a few hours later her pimp comes in with a pair of pants (she was without them) cause she as shooting up on a vein on her leg, a common procedure done by prostitutes cause guys get turned off when they see needle tracks on someone's forearm.

Shaquile O'Neal was born in that same hospital, and donated a unit to it. To honor him they had a mural of him on a wall in the hospital and just a few weeks after that mural was put up, someone vandalized it.

Back in those days, I was actually wishing a Punisher existed. It's no surprise that at that time his headquarters was in Newark NJ.
http://static.comicvine.com/uploads/scale_small/7/72648/1384034-punisher1.jpg

 

[microshar88]

Such a sad reality of life, you go into these professions to help people, endless debt, time away from family, and you also have to be afraid that you'll loose your life in the line of your work. I certainly will not be going to see someone I don't feel safe with, I will request a bodyguard to escort me.

 

[Ceke2002]

Apart from some verbal abuse I don't know of any actual physical abuse, or attempts at physical abuse that my Psychiatrist may have experienced. He's not a very big guy, but with the level of Martial Arts and Combat Defense training he has (several decades worth across a number of different countries) I'd hate to be a patient who did try anything on with him. I think they'd be in for a bit of a surprise.