Most entertaining job posting

[TexasPhysician]

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I saw this and found it both funny and sad. No one is ever taking this job:

Psych Duty Requirements:
Manage Joint Commission standards
Teach psych residents
Supervise NPP’s
Manage inpatients and consults and any “emergency” events
On call coverage with the potential to come in-person while on call

Non-Psych Duty Details:
Job is considered to be in a “hazardous area”
Must be able to “jog 1/4th mile and lift >30lbs”
Assist injured patients by “dragging or wheeling” them despite weighing “significantly more” than self.
“Stressful” environment
Must be able to get a security clearance

Pay:
Maximum of $130/hour. Minimum 30 hours/week.

This is a non-military job posting.

 

[Sushirolls]

Could be a military base contracting out to civilian sector.
Or a middle of nowhere community mental health clinic.

Or locums firm gets hired to fill it... they pay the doc $160/hr, and the firm gets $40/hr.
Because its better to bleed locums then improve the job.

 

[comp1]

I think it's an interesting job. Most inpatient jobs attached to a hospital with some admin responsibilities have these same requirements (minus the security clearance and possibly the needing to come in during call); they just don't spell them out so aggressively and they tend to pay a good deal better. Concur with this likely being a military contractor, but would love for the OP to post the actual listing firm if locums or site if not. I mean this is basically my job, again minus the security clearance and approaching 50% more pay when factoring in W2 stuff. It ultimately comes down to how many patients you actually see a day. I mean you could have all of this and still be at four patients a day (with residents and NPs), particularly at a military site.

 

[calvnandhobbs68]

I think it's an interesting job. Most inpatient jobs attached to a hospital with some admin responsibilities have these same requirements (minus the security clearance and possibly the needing to come in during call); they just don't spell them out so aggressively and they tend to pay a good deal better. Concur with this likely being a military contractor, but would love for the OP to post the actual listing firm if locums or site if not. I mean this is basically my job, again minus the security clearance and approaching 50% more pay when factoring in W2 stuff. It ultimately comes down to how many patients you actually see a day. I mean you could have all of this and still be at four patients a day (with residents and NPs), particularly at a military site.

lol no inpatient job I've ever seen has required you to:

“jog 1/4th mile and lift >30lbs”
Assist injured patients by “dragging or wheeling” them despite weighing “significantly more” than self.

It's like they mixed up the roles of a inpatient unit tech and a psychiatrist.

 

[Stagg737]

lol no inpatient job I've ever seen has required you to:

“jog 1/4th mile and lift >30lbs”
Assist injured patients by “dragging or wheeling” them despite weighing “significantly more” than self.

It's like they mixed up the roles of a inpatient unit tech and a psychiatrist.

Why hire a tech when you can just have the psychiatrist do their job at the same time!

 

[comp1]

All psychiatrists and any other staff who work on an inpatient unit should be trained and ready to assist with therapeutic containment in an emergency. It is certainly a formal requirement at all VAs (and I assume military hospitals where this post originated). You never know when you are going to need to pitch in. We're not somehow above this. The phrasing is certainly odd, but it is hard to assume they mean anything other than therapeutic containment.

 

[TexasPhysician]

All psychiatrists and any other staff who work on an inpatient unit should be trained and ready to assist with therapeutic containment in an emergency. It is certainly a formal requirement at all VAs (and I assume military hospitals where this post originated). You never know when you are going to need to pitch in. We're not somehow above this. The phrasing is certainly odd, but it is hard to assume they mean anything other than therapeutic containment.

Further digging - It appears to be an organization with many ex-military members bidding on a contract to run an immigration detention facility. The job doesn’t actually exist yet with them. They are trying to get enough low bidding professionals to provide the lowest bid and get the contract(s). There isn’t a psych residency there, so I’m assuming they are trying to get multiple contracts simultaneously. If this is how they are attracting talent, it is probably for the best that they don’t get the contracts.

 

[sloop]

I know you said it was a non-military listing but, as I was reading it, I was imagining some psychiatrist asking about everyone’s feelings while assisting with some sort of hot extract of a SEAL team. Like, dragging some dude by a plate carrier and yelling “I think this might be a great time to exercise our coping skills!”

 

[ObsequiousAplomb]

My residency job description (and the attending description there as well) definitely included being able to walk a certain distance in a certain speed (I wouldn't call it a jogging pace), that I could lift 50 pounds over my head, and that I could assist with physical holds (even though we were also barred from performing them by policy). I agree with others that frequently job descriptions have these things, though the expectation that a psychiatrist will actually do any of these things seems dubious. I always thought it was in there to give an excuse to fire someone for getting too old and frail.

 

[TexasPhysician]

My residency job description (and the attending description there as well) definitely included being able to walk a certain distance in a certain speed (I wouldn't call it a jogging pace), that I could life 50 pounds over my head, and that I could assist with physical holds (even though we were also barred from performing them by policy). I agree with others that frequently job descriptions have these things, though the expectation that a psychiatrist will actually do any of these things seems dubious. I always thought it was in there to give an excuse to fire someone for getting too old and frail.

Normally I’d agree that it is just copy/paste from their other generic jobs. This time it appeared to be one of the more reasonable qualifications. I’d prefer to jog 1/4th mile while holding 30lbs over dragging someone significantly heavier than myself. I’ve also never seen an employer admit to providing a stressful work environment.

 

[FatherPsychiatry]

ChatGPT can write Adderall and Zyprexa scripts better than anyone here, but its gonna be a while before it can jog 1/4th mile and lift >30lbs

 

[calvnandhobbs68]

All psychiatrists and any other staff who work on an inpatient unit should be trained and ready to assist with therapeutic containment in an emergency. It is certainly a formal requirement at all VAs (and I assume military hospitals where this post originated). You never know when you are going to need to pitch in. We're not somehow above this. The phrasing is certainly odd, but it is hard to assume they mean anything other than therapeutic containment.

The post above doesn't exactly seem to be referencing physical containment (sounds more like they want you dragging around injured patients or something?) but since this topic came up again....

Most psychiatrists and medical (non-nursing) staff members are in fact specifically NOT allowed to be part of physical hands on with any patients in any inpatient units I've been at unless they've received and practiced formal training around holds, restraints and coordination with team members on this.

I guess maybe less of a problem at the VA since they can't sue you but otherwise have fun getting the crap sued out of you when you inadvertently injure a patient by trying to hop yourself into a restraint/physical hold situation. Also, never heard of this when I rotated at the VA, it was literally never the protocol for any member of the medical team to go joining in on any attempts at physical containment.

 

[Merovinge]

The post above doesn't exactly seem to be referencing physical containment (sounds more like they want you dragging around injured patients or something?) but since this topic came up again....

Most psychiatrists and medical (non-nursing) staff members are in fact specifically NOT allowed to be part of physical hands on with any patients in any inpatient units I've been at unless they've received and practiced formal training around holds, restraints and coordination with team members on this.

I guess maybe less of a problem at the VA since they can't sue you but otherwise have fun getting the crap sued out of you when you inadvertently injure a patient by trying to hop yourself into a restraint/physical hold situation. Also, never heard of this when I rotated at the VA, it was literally never the protocol for any member of the medical team to go joining in on any attempts at physical containment.

Totally agree, spent a lot of time at the VA for both medical school and residency and know several VA staff psychiatrists none of whom took place with physical hold situations. The psychiatrist would walk the opposite direction of whoever was coming towards the patient. We go extremely far out of way to make sure to never be the person to touch the patient as the attending physician.

 

[ObsequiousAplomb]

ChatGPT can write Adderall and Zyprexa scripts better than anyone here, but its gonna be a while before it can jog 1/4th mile and lift >30lbs

nah, we all know it will hallucinate some aspect of the prescription. Or leave out a necessary prescription.

Admittedly, I went to the doximity chatgpt thing and it did a passable prescription, only it left out the indication and the route.

 

[comp1]

It's currently called "Prevention and Management of Disruptive Behavior" throughout the VA nationally and indeed rotating trainees (residents/medical students) are not trained in it due to its (very) extensive nature and as such they should not participate in containment. However, all VA attending, nursing and other staff who are employed in an inpatient psychiatric or ED setting are required to complete it to the highest level (currently called 3) so that they can participate in therapeutic containments where needed. I can't argue against some MDs in these settings existing who would walk (or run) away and I'm not even saying that attending MDs are always the best person to do it if there are multiple immediately available options, but they still should be ready and able to help. I get it's not a pleasant thing for anybody and will strain any sort of therapeutic alliance, but the attending gets to walk away afterwards. The nurses are stuck still being around the patient. It's a heck of a lot worse for them. And yes, the Federal Tort Claims Act is indeed a major benefit of working at the VA. The military has even less liability, although it can get murky for locums/contractors at either.

 

[michaelrack]

although I think psychiatrists should try and avoid getting involved in random holds/containment; a psychiatrist needs to know how to handle being attacked by a patient, which is usually part of this training (for example, "lean into a bite", rather than trying to pull away from a patient biting you.
Also, as part of this training is learning how to block a punch, and then maneuver the patient into a hold (while other staff comes to assist/take over).

 

[comp1]

Yes the above is currently called part 2 of the VA PMDB national training.

 

[docloufan]

although I think psychiatrists should try and avoid getting involved in random holds/containment; a psychiatrist needs to know how to handle being attacked by a patient, which is usually part of this training (for example, "lean into a bite", rather than trying to pull away from a patient biting you.
Also, as part of this training is learning how to block a punch, and then maneuver the patient into a hold (while other staff comes to assist/take over).

"Lean into the bite?" lol. Are you kidding me? Get real.

Anyone who physically attacks me is going to get really messed up. Period.

Why does it matter if they are a "mental patient" or not? There should be ZERO tolerance for this. All hospital systems have HUGE signs for this now...literally all over the place. And I've never seen one that says... 'unless you are a psychiatrist.'

 

[comp1]

The contrast here is so dramatic. One side saying they are going to wale on anybody posing a risk and the other that they are going to literally run away to "avoid liability." This is exactly why the training and associated job requirements are needed for psychiatrists and anybody else working on an inpatient unit.

 

[docloufan]

The contrast here is so dramatic. One side saying they are going to wale on anybody posing a risk and the other that they are going to literally run away to "avoid liability." This is exactly why the training and associated job requirements are needed for psychiatrists and anybody else working on an inpatient unit

No one should be doing any administration alphabet non-violence nonsense if they are physically attacked by a big and floridly psychotic mental patient or some State Hospital jailed psychopath. Why is that even controversial?

 

[Taddy Mason]

"Lean into the bite?" lol. Are you kidding me? Get real.

Ummm…it’s basic self-defense to safely get out of a bite. It forces the attacker’s jaw open, as well as throws off the attacker’s balance. Pulling/going the other direction is just going to inflict more damage to the individual being attacked. I say this as someone who has used this maneuver more than once, been both attacked and involved in restraining patients as both a tech/aid and resident, as well as trained in different self-defense protocols (some of which are admittedly BS), but this move is standard across them and does work effectively.

No one should be doing any administration alphabet non-violence nonsense if they are physically attacked by a big and floridly psychotic mental patient or some State Hospital jailed psychopath. Why is that even controversial?

As per my experience above you’re more likely to be attacked on inpatient CAP units than by adults - and I’ve worked in multiple state hospitals and correctional settings, including maximum security prisons.

 

[ObsequiousAplomb]

No one should be doing any administration alphabet non-violence nonsense if they are physically attacked by a big and floridly psychotic mental patient or some State Hospital jailed psychopath. Why is that even controversial?

Uh. Having worked in state hospitals and seeing several psychiatrists assaulted and the fallout of the assault, I sincerely hoping that's just bravado.

You should definitely do exactly what the policy is in any of those situations, because there is a policy. The facility will teach you how they want you to avoid situations but also how they want you to escape headlocks or punches. There 100% is a policy on how to respond and you will be expected to have followed it.

The altercation has an almost guaranteed 2 camera angles on it. Those videos will be reviewed ad nauseum in more committees than you thought existed. If you try to press charges on the patient and the video shows you punched a mentally ill patient who is being held involuntarily under your care ... What do you think the outcome will be for you? For your career?

 

[sloop]

Uh. Having worked in state hospitals and seeing several psychiatrists assaulted and the fallout of the assault, I sincerely hoping that's just bravado.

You should definitely do exactly what the policy is in any of those situations, because there is a policy. The facility will teach you how they want you to avoid situations but also how they want you to escape headlocks or punches. There 100% is a policy on how to respond and you will be expected to have followed it.

The altercation has an almost guaranteed 2 camera angles on it. Those videos will be reviewed ad nauseum in more committees than you thought existed. If you try to press charges on the patient and the video shows you punched a mentally ill patient who is being held involuntarily under your care ... What do you think the outcome will be for you? For your career?

I also have experience in these settings and I think my perspective lies somewhere between both of yours. You should absolutely try to avoid situations where you have to defend yourself against a patient. If it is possible, you should also try to use minimum necessary force to extricate yourself from the situation, using approved techniques if possible. What you say is true. They will review the video and use that as a basis for any possible employment or legal consequences to follow.

Having said that, everybody has a right to self-defense. That does not change because you are staff in a state hospital. While I have been at my current job, I have seen people seriously injured by patients. I know of people who were permanently disabled from assaults here. My patients have been discovered to have shanks on multiple occasions. At the end of the day, one needs to do whatever he or she thinks is necessary to defend their life, policy be damned. I am not going to be contemplating what administration is going to think as I get pummeled or stabbed. I am going to try to end the threat as quickly as possible.

 

[comp1]

Following the policy should fully align with what is necessary to defend your life. If it's not, you need to work on changing the policy (immediately) or find a new job. And indeed, you're not going to think much at all in such a high stress situation, that's why getting the training done is so important.

 

[sloop]

Following the policy should fully align with what is necessary to defend your life. If it's not, you need to work on changing the policy (immediately) or find a new job. And indeed, you're not going to think much at all in such a high stress situation, that's why getting the training done is so important.

The reality is that I have never had a psychiatric self-defense training that has taught techniques that I believe are appropriate to defend against a truly life-threatening situation, let alone what I have found out is a realistic scenario in which the patient might have a weapon.

Every one of these classes at the handful of institutions I have been part of focuses exclusively on techniques such as effectuating release from grasp/hair grab/bite. For obvious optics-related reasons, nobody has ever taught any type of strikes, but the reality is that it will very likely be necessary to strike a determined attacker in order to adequately defend oneself. If some patient has you in a corner and is pummeling you, no amount of releasing their grasp or trying to back away is going to help. You are going to need to strike that individual to have a decent chance of making it out without incurring grievous bodily harm.

I highly doubt any hospital is going to write down that they have a training policy that includes teaching strikes, but nearly every martial art recognizes that these are integral to self-defense.

 

[comp1]

Please don't start doing karate on patients. There should be training on containment in addition to escape for everyone who works on an inpatient or otherwise acute unit.

 

[sloop]

Please don't start doing karate on patients. There should be training on containment in addition to escape for everyone who works on an inpatient or otherwise acute unit.

Genuinely curious: how would you handle a situation where a patient with a shank has you cornered and is trying to stab you?

 

[Taddy Mason]

Genuinely curious: how would you handle a situation where a patient with a shank has you cornered and is trying to stab you?

 

[calvnandhobbs68]

Genuinely curious: how would you handle a situation where a patient with a shank has you cornered and is trying to stab you?

If you're following actual protocol on how to interact with patients in an inpatient setting you should never get "cornered" to begin with....so sounds like poor self awareness on your part. I'm not sure what's up with all the he-man stuff up top here.

 

[comp1]

There's a lot that being cornered (or a shank for that matter) could mean, but presumably it doesn't mean that you are tied down and gagged. So activating a portable panic alarm or otherwise alerting a need for help would be first. After this, you're going to look for evasion methods (covered in good quality trainings) while protecting your head and abdomen to the extent possible. But I do tend to agree that a combination of cornering and shank indicates several things went very wrong that should have been covered at lower levels of training and karate isn't likely to fix it.

 

[sloop]

If you're following actual protocol on how to interact with patients in an inpatient setting you should never get "cornered" to begin with....so sounds like poor self awareness on your part. I'm not sure what's up with all the he-man stuff up top here.

I’m sorry, but this is some straight up victim-blaming admin garbage. First of all, many of us work in less-than-ideal environments and this work is dangerous even with attempts to prevent assaults. Second, even assuming that being cornered is a priori evidence of negligent prevention, what are you implying? Are you saying that, because they made a mistake, such a person should just let the patient beat them to death while trying to strafe left and right like they were taught by the hospital training department?

There's a lot that being cornered (or a shank for that matter) could mean, but presumably it doesn't mean that you are tied down and gagged. So activating a portable panic alarm or otherwise alerting a need for help would be first. After this, you're going to look for evasion methods (covered in good quality trainings) while protecting your head and abdomen to the extent possible. But I do tend to agree that a combination of cornering and shank indicates several things went very wrong that should have been covered at lower levels of training and karate isn't likely to fix it.

Again, regardless of whether these situations can be prevented (and they cannot be 100% prevented, by the way . . . otherwise people wouldn’t regularly be getting murdered in prison), everyone has the moral right to defend oneself against threats of death or grievous bodily harm with proportionate force. You can be killed in seconds in a serious altercation. The personal alarm is great but you need to do whatever is necessary to get out of that situation as soon as possible. That may involve punching someone in the face or throat, kicking them in the groin, poking them in the eyes, whatever is necessary.

I am not advocating anybody go looking for a fight with patients. I am also not saying people should be striking patients in response to an assault when they can easily run away. I am just saying that nobody has an obligation to just let a patient seriously harm or kill them without striking back. You would absolutely be justified punching someone trying to jump you on the street in order to get away. That does not change just because you work at a hospital. To say otherwise is stupid physician martyrdom nonsense.

 

[calvnandhobbs68]

I’m sorry, but this is some straight up victim-blaming admin garbage. First of all, many of us work in less-than-ideal environments and this work is dangerous even with attempts to prevent assaults. Second, even assuming that being cornered is a priori evidence of negligent prevention, what are you implying? Are you saying that, because they made a mistake, such a person should just let the patient beat them to death while trying to strafe left and right like they were taught by the hospital training department?.

Idk why this has to be made crystal clear, but for all those trainees out there you should always keep your back to an exit and your front to the patient in an inpatient unit, especially if you’re in a situation where there aren’t multiple staff members present. You should also always be greater than arms length away from the patient. What less than ideal environment doesn’t allow you to follow those rules?

It really sounds like you’re just looking for an excuse to use your kung fu skills there John Wick.

 

[Bartelby]

I think a situation where you genuinely have to fight a patient is so rare as to be almost nonexistent, and the situation existing means many things failed to reach that point.

A good inpatient unit or ER has a lot in place to avoid getting to that point, such as:
-Designs that allow for good visibility (for example nursing station staff can see most of the unit)
-Searching all patients for weapons coming at their point of entry to the hospital
-Team observation and communication when a patient shows warning behaviors (anger, grievance, posturing, etc.)
-You observing carefully for signs of escalation, and being mindful when a patient might want to assault you (for example a particularly nasty hold)
-Generally ensuring other staff are around, especially when seeing a potentially violent patient
-Avoiding having a patient between you and an exit (patient in the doorway with you in the room, patient cornering you in a low-visibility part of the unit, etc.)
-De-escalating when signs of agitation arise, using the many skills of verbal redirection we develop over time and avoiding "kicking the hornet's nest" / being tone deaf to the developing situation

When things do get to the point of assault if we are talking an elderly patient taking a swing at you, or a young psychotic man shoving you, the strategy if at all possible is to remove yourself from the situation ASAP. Attract attention and move. Fist fighting the patient should not be on the menu at that point.

But with all that said, I have heard of situations where the swiss cheese all lined up and a provider found themself in a serious struggle. For example, I knew one ER psychiatrist who had no suspicion a patient would become violent. While walking out of the room the patient quickly jumped up, got him to the ground, and started full-force choking him. Other staff made it there pretty quickly to assist and no permanent physical harm was done (but plenty of psychological harm!), but this is obviously a dangerous situation.

In those extraordinarily rare situations (that for most of us should not happen in a career, but unfortunately do happen at times) using any amount of force necessary to preserve your own safety is the right call. If a strong young man is on top of you choking you with no help present, gouge his eye, try to knee his groin as forcefully as you can, bite, or do anything else you have to to preserve your own life. I think because most of us are (thankfully) removed from life-threatening violence in our daily lives and because situations posing imminent risk of killing or permanently disabling us are exceedingly rare, we forget that in some extremely unusual situations serious violence can be the right response. The book "When Violence in the Answer" provides an interesting overview.

But I think the tl;dr is most of will never and should never physically fight a patient, but for the very rare provider who finds themself in a genuinely life or death situation I hope they recognize it for what it is and respond in any way that keeps them alive. I think every healthcare provider has the right to genuine self defense and the responsibility to avoid reaching that point with every tool at their disposal.

 

[calvnandhobbs68]

🤣 I'm honestly not sure how this thread keeps devolving into "be ready to cage fight patients if needed" from "seems weird to have a job description where a psychiatrist has to drag around injured patients".

 

[docloufan]

Please don't start doing karate on patients. There should be training on containment in addition to escape for everyone who works on an inpatient or otherwise acute unit.

Yea man. No. Talking about weapons/shanks. Or obese, institutionalized mental patients with little left to lose. Murderers. Rapists, etc. This isn't about someone taking a swing at you on 6 north of the local medical center.

And again, yea man. Containment, escape options. Doesn't always work-out like that. It's an imperfect world. No one should be tolerating abuse because someone is nuts, suboptimal monitored, and/or because the intuition you work for said you should have followed a "non-violence procedure." Ridiculous.

 

[Taddy Mason]

Yea man. No. Talking about weapons/shanks. Obese, institutionalized mental patients with little left to lose. Murderers. Rapists, etc. This isn't about someone taking a swing at you on 6 north of the local medical center.

And again, yea man. Containment, escape options. Doesn't always work-out like that. It’s an imperfect world. No one should be tolerating abuse because someone is nuts, suboptimal monitored, and/or because the intuition you work for said you should have followed a "non-violence procedure." Ridiculous.

You’re either trolling and/or have little to no experience with this population - especially based on your language choices.

 

[docloufan]

You’re either trolling and/or have little to no experience with this population - especially based on your language choices.

ok buddy. Have fun tangoing with the Zyprexa obese schizo at the state hospital whilst you..."lean into the bite..."

 

[sloop]

Idk why this has to be made crystal clear, but for all those trainees out there you should always keep your back to an exit and your front to the patient in an inpatient unit, especially if you’re in a situation where there aren’t multiple staff members present. You should also always be greater than arms length away from the patient. What less than ideal environment doesn’t allow you to follow those rules?

It really sounds like you’re just looking for an excuse to use your kung fu skills there John Wick.

It’s telling that you don’t actually answer my questions, and instead set up some straw man caricature.

I’ll ask again: is it your position that if someone makes a mistake on the prevention end, they should be barred from striking an attacking patient even if that would prevent serious injury or death?

 

[ObsequiousAplomb]

Genuinely curious: how would you handle a situation where a patient with a shank has you cornered and is trying to stab you?

1 not walking into corners
2 running as fast as I can
3 taking staff with me, ideally in between me and the patient
4 this is why I don't work inpatient anymore

 

[Stagg737]

It’s telling that you don’t actually answer my questions, and instead set up some straw man caricature.

I’ll ask again: is it your position that if someone makes a mistake on the prevention end, they should be barred from striking an attacking patient even if that would prevent serious injury or death?

Honestly depends on where the mistake in prevention took place. If it's a policy problem and the facility failed to recognize a risk, then I don't see issue with a doc defending themselves appropriately. However, I'd also ask why the physicians weren't recognizing this problem and bringing it up themselves. If a facility is forcing someone to work in a high risk environment and not providing appropriate safety measures and the psychiatrists accepts those risks, it's on them. I asked about safety protocols and how certain situations were handled at the places I interviewed. Responses to those questions are actually great ways to gauge if they'll be a decent employer.

If there are measures in place that the doc ignores or if a doc just doesn't follow basic safety protocols (ie, goes and stands in a corner while an aggressive and psychotic/high patient rages near the door) then that's on them. If it's an avoidable situation that occurred because the doc ignored safety protocols or didn't use common sense and they have to harm the patient to protect themselves then that's on the doc and they should absolutely be liable with certain patients. That said, the patient's state matters. Someone who is generally stable but is delirious post-operatively that a doc punches because the patient was disoriented and sat up in bed and bit them is very different from getting attacked by someone who is just antisocial.

It's weird to me that people are trying to come up with scenarios where punching a patient would be justified. Is it possible? Sure, I guess if you're working on a forensic unit or prison where an antisocial patient attempts assault. But in 99.9% of scenarios it's completely avoidable by following basic policies and using common sense.

 

[ObsequiousAplomb]

ok buddy. Have fun tangoing with the Zyprexa obese schizo at the state hospital whilst you..."lean into the bite..."

With a high enough Zyprexa dose X a variable amount of time, that patient eventually becomes one that can be outrun.

In state hospital settings, sometimes that means you ask the nurse before going on the unit and decide to not walk on the unit for a few weeks until that patient becomes low risk enough. When they become acutely agitated, the psychiatrists doesn't need to come within swinging range to place an order for an IM. If it's a hospital that houses someone that violent, then it's a hospital the psychiatrist isn't expected to live on the unit. The ones where I have been have interview rooms that way there can always be two large behavioral health technicians blocking the patient from getting to you.

If a patient can overcome two large grown men to attack me, then really there isn't much that can be done.

In most violent correctional settings, you can usually see the inmates while they are in cuffs or again, with multiple large guards between you and them.

 

[sloop]

Honestly depends on where the mistake in prevention took place. If it's a policy problem and the facility failed to recognize a risk, then I don't see issue with a doc defending themselves appropriately. However, I'd also ask why the physicians weren't recognizing this problem and bringing it up themselves. If a facility is forcing someone to work in a high risk environment and not providing appropriate safety measures and the psychiatrists accepts those risks, it's on them. I asked about safety protocols and how certain situations were handled at the places I interviewed. Responses to those questions are actually great ways to gauge if they'll be a decent employer.

If there are measures in place that the doc ignores or if a doc just doesn't follow basic safety protocols (ie, goes and stands in a corner while an aggressive and psychotic/high patient rages near the door) then that's on them. If it's an avoidable situation that occurred because the doc ignored safety protocols or didn't use common sense and they have to harm the patient to protect themselves then that's on the doc and they should absolutely be liable with certain patients. That said, the patient's state matters. Someone who is generally stable but is delirious post-operatively that a doc punches because the patient was disoriented and sat up in bed and bit them is very different from getting attacked by someone who is just antisocial.

It's weird to me that people are trying to come up with scenarios where punching a patient would be justified. Is it possible? Sure, I guess if you're working on a forensic unit or prison where an antisocial patient attempts assault. But in 99.9% of scenarios it's completely avoidable by following basic policies and using common sense.

No. It doesn’t matter if it is a patient or a random person on the street. A human being is entitled to use proportionate force to defend against an attacker, period. Again, this is administrative victim-blaming BS. Are you also telling women it was their fault because they dressed too provocatively in a bad part of town and weren’t aware of their surroundings?

The fact that you think these things are 100% preventable and have some expectation that a person being attacked should just give up if their actions may have constituted inadequate prevention just tells me that you don’t work in settings with a high risk of violence. I work in a forensic hospital and the patients are dangerous. You can be as careful as possible but, if a patient wants to target you and make a shank, you could easily be toast. You can’t have everyone on 1:1, and a patient could tackle you on the way back to your office.

I have never been talking about beating up a delirious patient who takes a lone swing on you. Read my posts—I’m pretty explicit about that. At the same time, the idea that a scenario where you would be forced to actually fight a patient in self-defense is extraordinarily remote is itself extraordinarily naive. Take a job primarily working with justice-involved patients and you might be surprised how quickly your perspective changes.

I am all for treating patients humanely as well as trying to minimize restrictive interventions and physical altercations involving patients. I genuinely am. At the same time, your right to self-defense is inalienable and does not change because you are in a hospital dealing with patients.

 

[Taddy Mason]

…the idea that a scenario where you would be forced to actually fight a patient in self-defense is extraordinarily remote is itself extraordinarily naive. Take a job primarily working with justice-involved patients and you might be surprised how quickly your perspective changes.

I have worked in multiple such settings (i.e., forensic units, state hospitals, jail wards, court clinics, and more than one maximum security prison) and have honestly seen more violence/assaults in community settings. So if anything, it’s skewed my perspective in the opposite direction. However, the more serious assaults I’ve been aware of all could have been avoided and there was a degree of provocation on the fault of the individuals assaulted. Not victim blaming, just the black and white facts of what went down.

 

[sloop]

With a high enough Zyprexa dose X a variable amount of time, that patient eventually becomes one that can be outrun.

In state hospital settings, sometimes that means you ask the nurse before going on the unit and decide to not walk on the unit for a few weeks until that patient becomes low risk enough. When they become acutely agitated, the psychiatrists doesn't need to come within swinging range to place an order for an IM. If it's a hospital that houses someone that violent, then it's a hospital the psychiatrist isn't expected to live on the unit. The ones where I have been have interview rooms that way there can always be two large behavioral health technicians blocking the patient from getting to you.

If a patient can overcome two large grown men to attack me, then really there isn't much that can be done.

In most violent correctional settings, you can usually see the inmates while they are in cuffs or again, with multiple large guards between you and them.

Sorry, but much of this is not true:

I work in a maximum security forensic hospital. My office is on the unit. As a fellow, I worked at a different maximum security forensic hospital in a different state. The psychiatrist offices were on the unit (even worse, they did not have windows on the doors and opened up directly into a patient hallway).

As a fellow, I worked in two different jails. In one of them, the detainees were shackled to a chair, in the other they were cuffed but still mobile. You would be surprised how much damage even a shackled detainee can do in a short period of time. I had the extremely educational experience of being alone in a small office (door opened) with a detainee who demanded benzodiazepines and then immediately became irate, stood up, and blocked the door when I did not prescribe them. COs came quickly from down the hallway but, if that person had assaulted me, I would have had no choice but to try to fight my way out.

At my current institution, we utilize what I sometimes refer to as the “Putin Method,” where the patient is literally on the other side of a very large room, and we speak from across the room with staff present. You would be surprised how quickly patients can get to you. I have had to intervene in an assault against another psychiatrist who the patient was able to get to despite this. Other psychiatrists have gotten bitten by HIV-positive patients, pinned against walls by patients, etc. It is also not entirely possible to predict who will be violent. I have been completely shocked when patients who were previously completely appropriate attacked staff.

The reality of many correctional and forensic environments is not pretty. The funding and political will does not exist to fix many of these places, but the patients still need care. People need to be able to go to work and at least know that they can do whatever they need to escape a life-threatening assault.

 

[sloop]

I have worked in multiple such settings (i.e., forensic units, state hospitals, jail wards, court clinics, and more than one maximum security prison) and have honestly seen more violence/assaults in community settings. So if anything, it’s skewed my perspective in the opposite direction. However, the more serious assaults I’ve been aware of all could have been avoided and there was a degree of provocation on the fault of the individuals assaulted. Not victim blaming, just the black and white facts of what went down.

Respectfully, my experience in these same settings has been different. See my above post.

For the record, I definitely think some people are bad at interacting with mentally ill patients and provoke the patients (though not usually in the legal/moral sense as it relates to self-defense, more just that they are bad at deescalation and begin to argue with the patient when they should be disengaging). Many of those people should be fired as they are not suitable for working with these patients. That doesn’t really, in my view, change the fact that they are entitled to defend their life by whatever means are reasonably necessary given the situation.

 

[Stagg737]

No. It doesn’t matter if it is a patient or a random person on the street. A human being is entitled to use proportionate force to defend against an attacker, period. Again, this is administrative victim-blaming BS. Are you also telling women it was their fault because they dressed too provocatively in a bad part of town and weren’t aware of their surroundings?

The fact that you think these things are 100% preventable and have some expectation that a person being attacked should just give up if their actions may have constituted inadequate prevention just tells me that you don’t work in settings with a high risk of violence. I work in a forensic hospital and the patients are dangerous. You can be as careful as possible but, if a patient wants to target you and make a shank, you could easily be toast. You can’t have everyone on 1:1, and a patient could tackle you on the way back to your office.

I have never been talking about beating up a delirious patient who takes a lone swing on you. Read my posts—I’m pretty explicit about that. At the same time, the idea that a scenario where you would be forced to actually fight a patient in self-defense is extraordinarily remote is itself extraordinarily naive. Take a job primarily working with justice-involved patients and you might be surprised how quickly your perspective changes.

I am all for treating patients humanely as well as trying to minimize restrictive interventions and physical altercations involving patients. I genuinely am. At the same time, your right to self-defense is inalienable and does not change because you are in a hospital dealing with patients.

What a ridiculous and irrelevant comparison the bolded is. Get that politicized crap out of here. There are risks to certain jobs that we accept and that is our own responsibility. That has nothing to do with victim blaming or asking for it. If an administration isn't protecting its employees adequately, don't work there. Period.

As I said before, there are exceptions, I even included antisocial patients like you're talking about as one of them. I never said 100%, so don't misrepresent my statements. I've worked in high risk settings. I understood the risks when I did and actively took steps to avoid them (twice preventing situations where I would have definitely been harmed by antisocial patients if I hadn't). I work with justice-involved patients in the ER all the time. I was often the first contact, so I'm fully aware of those risks. I have worked with them in other settings as well. Some of these experiences are why I'm not currently in forensics despite enjoying it. I'm not willing to take on that risk while I have small kids, even if it is relatively low in many places.

At the end of the day, the people working in these positions are choosing to do so. Like I said, I can see scenarios where having to use greater force to defend oneself may be necessary. But working with patients like the ones you see you must recognize that these patients often don't care about boundaries or other people's "rights". Someone else mentioned it above, but frankly if one these individuals attacks staff throwing punches or strikes isn't going to be what saves the victim unless they've got some pretty solid training in how to fight so I don't even know why this is even relevant.

 

[sloop]

What a ridiculous and irrelevant comparison the bolded is. Get that politicized crap out of here. There are risks to certain jobs that we accept and that is our own responsibility. That has nothing to do with victim blaming or asking for it. If an administration isn't protecting its employees adequately, don't work there. Period.

As I said before, there are exceptions, I even included antisocial patients like you're talking about as one of them. I never said 100%, so don't misrepresent my statements. I've worked in high risk settings. I understood the risks when I did and actively took steps to avoid them (twice preventing situations where I would have definitely been harmed by antisocial patients if I hadn't). I work with justice-involved patients in the ER all the time. I was often the first contact, so I'm fully aware of those risks. I have worked with them in other settings as well. Some of these experiences are why I'm not currently in forensics despite enjoying it. I'm not willing to take on that risk while I have small kids, even if it is relatively low in many places.

At the end of the day, the people working in these positions are choosing to do so. Like I said, I can see scenarios where having to use greater force to defend oneself may be necessary. But working with patients like the ones you see you must recognize that these patients often don't care about boundaries or other people's "rights". Someone else mentioned it above, but frankly if one these individuals attacks staff throwing punches or strikes isn't going to be what saves the victim unless they've got some pretty solid training in how to fight so I don't even know why this is even relevant.

It is not a ridiculous comparison. Isn’t that what the victim-blamers say about women who get sexually assaulted—that they knew that they were in a bad area of town after dark and they chose to wear revealing clothing, get drunk, lose awareness of their surroundings, etc., so they are somehow at least partially to blame for what happened? How is this different than you saying that I know the risks when I go to work, or maybe I lost awareness or met with a patient in the wrong room? And so what, exactly? I deserve what happens to me? I shouldn’t aggressively fight back?

I deeply care about my patients. I genuinely do. I am the first in my hospital to advocate that they be treated fairly, humanely, and in the least restrictive way possible. At the same time, my life has the same intrinsic value that the patient’s does. If I am in a serious, dangerous altercation with a patient, it doesn’t matter to me how we got there. I am going to fight to my last breath to make sure I can go home and see my family. If someone has a problem with that, they can take it up with the Attorney General, the local prosecutor, or hospital administration. I don’t care.

I take risks to my personal safety every time I enter the hospital in order to provide my patients with high quality medical care. I have had patients call hits on me, try to assault me, etc. I don’t get paid a fortune. I come to work because I feel that everyone deserves high quality care regardless of their life circumstances, and because somebody has to be willing to protect the patients from harm in a coercive system. I sacrifice enough. I will not feel guilty for ruthlessly defending my life and safety if I encounter a scenario where that is necessary.

 

[docloufan]

With a high enough Zyprexa dose X a variable amount of time, that patient eventually becomes one that can be outrun.

In state hospital settings, sometimes that means you ask the nurse before going on the unit and decide to not walk on the unit for a few weeks until that patient becomes low risk enough. When they become acutely agitated, the psychiatrists doesn't need to come within swinging range to place an order for an IM. If it's a hospital that houses someone that violent, then it's a hospital the psychiatrist isn't expected to live on the unit. The ones where I have been have interview rooms that way there can always be two large behavioral health technicians blocking the patient from getting to you.

If a patient can overcome two large grown men to attack me, then really there isn't much that can be done.

In most violent correctional settings, you can usually see the inmates while they are in cuffs or again, with multiple large guards between you and them.

Dude...

 

[Stagg737]

It is not a ridiculous comparison. Isn’t that what the victim-blamers say about women who get sexually assaulted—that they knew that they were in a bad area of town after dark and they chose to wear revealing clothing, get drunk, lose awareness of their surroundings, etc., so they are somehow at least partially to blame for what happened? How is this different than you saying that I know the risks when I go to work, or maybe I lost awareness or met with a patient in the wrong room? And so what, exactly? I deserve what happens to me? I shouldn’t aggressively fight back?

I deeply care about my patients. I genuinely do. I am the first in my hospital to advocate that they be treated fairly, humanely, and in the least restrictive way possible. At the same time, my life has the same intrinsic value that the patient’s does. If I am in a serious, dangerous altercation with a patient, it doesn’t matter to me how we got there. I am going to fight to my last breath to make sure I can go home and see my family. If someone has a problem with that, they can take it up with the Attorney General, the local prosecutor, or hospital administration. I don’t care.

I take risks to my personal safety every time I enter the hospital in order to provide my patients with high quality medical care. I have had patients call hits on me, try to assault me, etc. I don’t get paid a fortune. I come to work because I feel that everyone deserves high quality care regardless of their life circumstances, and because somebody has to be willing to protect the patients from harm in a coercive system. I sacrifice enough. I will not feel guilty for ruthlessly defending my life and safety if I encounter a scenario where that is necessary.

It is absolutely ridiculous. Saying that this is something we recognize is a potentially dangerous situation and accept the risks of does not mitigate the risks. This has nothing to do with what is "deserved" or the comparison you're making where someone isn't aware of their surroundings or situation and gets assaulted. You are actively talking about how dangerous your job is. You clearly know the risks and choose to work there. I'm not saying you "deserve" anything bad coming your way and I'm also not saying you shouldn't fight back against antisocial patients attacking you.

What I am saying is that there is idealistic views of what "should be" and there is reality. You mentioned procedures in place where you've worked to prevent these risks, but still say you feel like it's not enough or have seen it not be enough. What I'm saying is that throwing some punches or fighting back is unlikely to make much of a difference unless you're trained to do so which is partially where policies and training like what has been talked about comes in. I'm not sure why you seem to be taking this personally, but I'm truly not trying to suggest you're deserving of anything bad. I'm just very much a realist, partially by nature and partially formed experiences, and focus on what we can control.

Going along with that, I've seen people try and fight back plenty of times. The people who are successful are almost always ones who are (extensively) trained in some way and have high situational awareness (aka were prepared to defend themselves). Sometimes someone will catch their attacker off guard and get lucky, but not usually. Again, just being a realist.

Last point, my initial response to you was talking about psychiatric settings in general which I thought was pretty obvious. Clearly your setting is different and highly atypical compared to 95%+ of where docs will practice which is also why there should be so many mitigation policies and procedures. Somehow me saying that not wailing on delirious, elderly patients turned into a defense of you protecting yourself from antisocial criminals. Like I said, there are very, very rare situations in our field (which may have a higher rate in your setting) that could possibly warrant extreme measures for self-defense. But as I and many others have said, if things actually get to the point where that's necessary the doc is already completely screwed anyway.

 

[Sanman]

It's currently called "Prevention and Management of Disruptive Behavior" throughout the VA nationally and indeed rotating trainees (residents/medical students) are not trained in it due to its (very) extensive nature and as such they should not participate in containment. However, all VA attending, nursing and other staff who are employed in an inpatient psychiatric or ED setting are required to complete it to the highest level (currently called 3) so that they can participate in therapeutic containments where needed. I can't argue against some MDs in these settings existing who would walk (or run) away and I'm not even saying that attending MDs are always the best person to do it if there are multiple immediately available options, but they still should be ready and able to help. I get it's not a pleasant thing for anybody and will strain any sort of therapeutic alliance, but the attending gets to walk away afterwards. The nurses are stuck still being around the patient. It's a heck of a lot worse for them. And yes, the Federal Tort Claims Act is indeed a major benefit of working at the VA. The military has even less liability, although it can get murky for locums/contractors at either.

Not sure I would consider PMDB level 3 to be very extensive training especially the portion regarding approved physical interventions. Does it ever bother you that you are only given a few hours of training on how to defend against folks that the government spent weeks to months training to kill you?

Given the short staffing of some VA inpatient units and physically violent nature of some of the patients, not something I would be willing to solely rely on. We had a few significant staff injuries recently on our inpatient unit (which was full despite short staffing).