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Psych Patient Question

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justclouds9000

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For practicing psychiatrists in private outpatient practice- what proportion of your patients are stable enough to be enjoyable to work with on some level? Also, how often do you feel unsafe in your one- on -one sessions? I've heard that physical attacks on mental health providers are relatively common and wonder how much of an issue that is in private outpatient practice and how people deal with this psychologically.

I'd appreciate any feedback. I'm considering psychiatry and I've been thinking about this aspect of the specialty. I'm trying to get a feel for the type of practice settings available and what the pros and cons of working with different patient types are.
 

splik

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I've heard that physical attacks on mental health providers are relatively common and wonder how much of an issue that is in private outpatient practice and how people deal with this psychologically.
Physical attacks are uncommon in psychiatry, but certainly an occupational hazard. If you are frequently being attacked, it's your fault. In outpatient practice, most psychiatrists screen patients appropriately, are not seeing seriously mental ill patients, and select patients who dont have the risk factors that go along with violence (e.g. poor insight, unrepentent substance abuse, history of violence, non-adherence to treatment, active psychosis, lack of social support, personality disorder/psychopathy etc). You are much more likely to be stalked, harassed, or (most common) have a patient fall in love with you than be attacked by a patient in outpatient private practice.

Now in psychiatric emergency department, involuntary inpatient psych units, and some community mental health settings this is a higher risk of being attacked, and many things one can do to reduce their risk of being a target including using alarm systems, learning self-defense, employing de-escalation technqiues, and working to systemically reduce risk of workplace violence.
 
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WisNeuro

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Even when I did evaluations that had an impact on service connection claims, I was never threatened. No other real threatening situations (from my point of view). I did have an individual with Borderline PD who told another provider about homicidal fantasies, something about shooting me and another provider. But I never really felt unsafe, I had plenty of experience with Borderline PD and the patient was searched and escorted after that, and we continued to engage in therapy. But that's the only thing I can think of in more than a decade of providing clinical work in one context or another. Even in the clinics I have been in, I've only been working in one instance of one provider who had a patient lay hands on them (choking). Just my experience, different settings have different base rates, obviously.
 

Attending1985

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For practicing psychiatrists in private outpatient practice- what proportion of your patients are stable enough to be enjoyable to work with on some level? Also, how often do you feel unsafe in your one- on -one sessions? I've heard that physical attacks on mental health providers are relatively common and wonder how much of an issue that is in private outpatient practice and how people deal with this psychologically.

I'd appreciate any feedback. I'm considering psychiatry and I've been thinking about this aspect of the specialty. I'm trying to get a feel for the type of practice settings available and what the pros and cons of working with different patient types are.
I haven’t felt unsafe yet but I’m early in my career. I think most would agree that the biggest frustration in psychiatry is the system and not the patients.
 
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I've had a few patients attempt to hit me, none succeeded. They were already high violence risk (antisocial and coming down from subtances; acutely manic) and in ED / Inpatient settings. If you're good at reading body language/affect, most assault attempts are predictable enough that you should already be making distance before they actually try to assault you. It does happen that people get clocked literally out of nowhere (stable/docile psychosis who hadn't ever been violent before and suddenly lashes out at a passer-by or fellow patient), but it's much more rare. Watch your back on the unit.
 
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Mass Effect

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As a resident, I was threatened in our outpatient clinic by a suicidal borderline who was afraid I was going to hospitalize her. I was assaulted by a patient in ED.
 

clausewitz2

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Have had one newly psychotic young man lunge across a table and knock me back trying to get at papers I had he was convinced pertained to him (they did not, but lesson learned, no visible papers). A less-newly psychotic gentleman bull-rushed me in our psych ED and smashed the clipboard I was holding into pieces because he wanted to be admitted and felt this would force our hand. A lady with FTD threatened to punch me if I asked her to do "that stupid lion and camel-naming test". Never felt seriously threatened in those situations but learned my lesson and now stay a kick and a half distance from people who are properly agitated.

Had co-residents get popped on our geriatric unit by very demented, keyed up wanderers who just kept moving afterward like nothing happened. Shuffle shuffle shuffle SMACK shuffle shuffle.

 
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