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Patient threats (out of the hospital)

Discussion in 'Psychiatry' started by Ritz, May 12, 2008.

  1. Ritz

    Ritz 2+ Year Member

    Apr 25, 2008
    Has anyone been threatened by a patient outside of the hospital ? And how did you react to it ?
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  3. KHE

    KHE Senior Member Optometrist SDN Advisor 10+ Year Member

    Jun 14, 2005
    I'm only responding to this thread because I saw it on the main page and the title "threatened by a patient" caught my eye because I was threatened today.

    I am an optometrist and I had an 89 year old man today come for an eye exam to get his driver's license renewed. He threatened to "kick my ***" if I didn't pass him, and he was definately NOT joking. Fortunately, his vision was more than adequate, so I never had to deal with it but I haven't been threatened in a long time. I'm sure as psychiatrists you guys deal with it all the time, which is one of the main reasons I went into optometry!
  4. whopper

    whopper Former jolly good fellow Physician Faculty 10+ Year Member

    Feb 8, 2004
    I haven't but some of my colleagues or attendings have been threatened.

    For that reason, even though my program has never made an official statements on it, I tell fellow residents not to volunteery their private information such as phone numbers, addresses or similar things.

    I always had what I call a healthy paranoia about such things. I'm a big fan of the newer version of Cape Fear with Robert Deniro, where an antisocial stalker ruins the life of his ex-lawyer.

    However and I learned this later on, the more mentally sick the patient, often times the less they're able to carry out a plan where they're out to ruin someone's life & carry out elaborate planning.

    But don't kid yourself. It still happens.

    The closest thing that happened to me was a guy in the inpatient unit that had to take down with haldol threatened to kick my butt. The guy was over 6.5 feet tall & had a lot of muscle. The guy looked like a pro NFL quarterback.

    1 month later I saw him at a local DVD store, and the first thing that hit my mind was "get the heck out of here". He spotted me but was very calm with me. When the guy was on inpatient he was psychotic, we got him under control & when I saw him later-he was in control & on meds. He acted as if the event never happened.

    As for the person I know that was threatened (patient called her home making threats), she put a restraining order on the patient. I was a bit bugged because it seemed the hospital system merely wrote it off as a psychotic patient and there was nothing to worry about because all that had to be done was the get the patient medicated again. This attending has 3 kids, 1 of which was an infant at the time, so psychotic or not, a threatening patient that knows where you live isn't exactly a comforting thought.

    Another story was a buddy of mine, his father is an Ob-Gyn and delivered a baby that ended up dying. The father of that child threatened to kill my buddy's dad, and actually fired on his car with an Uzi while the guy was driving on the highway. The cops caught the guy & arrested him.

    Last story I had was a doctor that occasionally teaches at my institution told me a patient of his left threatening messages in code and wanted drugs of abuse such as xanax that the doc felt the patient had no use for other than to get high. The patient was in the military, had several kills & was an expert sniper. The patient left messages that on paper did not reveal a direct threat but were meant to scare, e.g. stuff like "you better give me the xanax or you'll be disappointed". Well that doc was fine but he said he actually had to look over his shoulder for a few weeks.
  5. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus 10+ Year Member

    Sorry, I just found that part funny.

    I probably would have answered "alright big guy. Let's give this test a shot."

    I've had quite a few patients threaten to wait for me "outside the hospital" after I've kicked them out of the ER, etc. You can either leave with an escort, have the guy escorted off the grounds by the cops, or something similar. In one particular case, a viscious multi-incarcerated sociopath whom I kiced off the inpatient service, I was actually truly nervous.

    Luckily, I feel that I can take care of myself in most cases. I imagine it would be tougher or more nerve-wracking if you're built like Caspar Milquetoast.
  6. 187502


    Feb 5, 2008
    BF-MW, USA
    I knew a family friend, psychiatrist, 70+ yrs old, that saw outpatient in a little office she had added onto her house! I thought she was nuts.
  7. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus 10+ Year Member

    I think that's possible if you cherry-pick your patients and leave the psychosis and borderlines out.
  8. whopper

    whopper Former jolly good fellow Physician Faculty 10+ Year Member

    Feb 8, 2004
    Unless that doc only referred her most trusted & stable patients to her home, I don't think such an idea is safe.

    IMHO every outpatient office needs a panic button system.
  9. Ritz

    Ritz 2+ Year Member

    Apr 25, 2008
    I was talking about threats not in the Hospital campus. This happened in the street, while going from one building to the other and the patient had been discharged from the In Pt unit. Kind of new experience as this was a stable pt.
    I am not sure if I will like to get Physical with a patient even if I was the Hulk - btw we got training in Self Defense :)
  10. Anasazi23

    Anasazi23 Your Digital Ruler Moderator Emeritus 10+ Year Member

    Ah, yes. That's more tricky.

    I remember once I was in the same subway car as a man I had discharged from the unit under less than pleasant circumstances. The exchange went smoothly, luckily.

    In that case, depending on where you are, i imagine that the best thing is to keep moving into a public/more crowded place and preferably get police help asap. Obviously a physical altercation is best left avoided, if one can help it. If not, then not. I'm glad it worked out ok for you.

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