PSYCH patients and your safety

[DazedMD]

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Hi everyone. I've been posting for a few months now, trying to decide what to go to residency for or to even continue at all for that matter.

Lately I've been thinking about psych. For those of you in residency and out in private practice, have you ever felt scared by your patients. Ever been worried about your personal safety? Has a patient ever stalked you or threatened to harm you or your family.

When rotating during 3rd year at the state mental hospital and on ER psych, many of the patients were very aggressive. As a female, I wonder how I would feel in this environment constantly.

Psych is very interesting to me, especially schizophrenia but I don't necessarily feel safe being around many psych patients.

After residency, I'm sure everything would be fine. I could tailor my practice and not expect people who freak me out.

What do you guys think? Does this feeling get better?

 

[TheCat]

haha well comparing your experience at a state mental hospital and a ER pysch facility is hardly representative of an outpatient practice-All outpatient psych docs see none of that really dysfunctional psychopathology-I mean rarely do you treat a schizo or a completely pscyhotic etc. you probably get the odd borderline that is more of a hassle to treat but you tailor your practice to treat what you want-and most poeple that can pay are people that are pretty functional which means not too severe of disease.

Even if you worked as an inpatient doc or a forensics doc-I am sure they would have trouble finding where you live-im sure they make that info hard to obtain.

Good luck though-I was unsure about psych until the end of my 3rd year and even then wasnt sure but im a 4th year and 2 elecitves down and I could not be more excited-I find psych facinating! gluck!

 

[DazedMD]

haha well comparing your experience at a state mental hospital and a ER pysch facility is hardly representative of an outpatient practice-All outpatient psych docs see none of that really dysfunctional psychopathology-I mean rarely do you treat a schizo or a completely pscyhotic etc. you probably get the odd borderline that is more of a hassle to treat but you tailor your practice to treat what you want-and most poeple that can pay are people that are pretty functional which means not too severe of disease.

Even if you worked as an inpatient doc or a forensics doc-I am sure they would have trouble finding where you live-im sure they make that info hard to obtain.

Good luck though-I was unsure about psych until the end of my 3rd year and even then wasnt sure but im a 4th year and 2 elecitves down and I could not be more excited-I find psych facinating! gluck!

Thanks for your advice. Any others out there???

 

[nortomaso]

sadly:


http://www.washingtonpost.com/wp-dyn/content/article/2006/09/03/AR2006090301019.html

 

[DrIng]

Statistically you are most likley to get attacked by a patient as an ED doctor or working in orthopedics... With psych patients you can mostly see it coming- if you're interviewing someone and they start pacing up and down the room and clenching their fists then you're 'asking for it' if you persist with the interview but mostly people respond well to 'you're looking rather worked up, how about we continue this later on' and then again I've also interviewed someone with 4 or 5 large security guards standing around as well... Don't let the fear of a few aggressive patients put you off a facinating career, the fear is eal but largely manageable.

 

[fiatslug]

that's just so terribly sad.

 

[whopper]

I have never felt scared in the hospital. The security in my hospital is great. They're there in seconds. The staff can tell when a patient will get out of line before it happens.

The danger situation depends on the hospital. The same hospital for example, from what I was told-the security was not so safe about 10 years ago. If a patient got out of line, 1 security guard would show up several minutes later who was an old man. Now they show up almost immediately--a bunch of burly 6 foot guys surround the patient immediately.

Outpatient--I never had a problem yet but the thought did cross my mind that at some point you might get a patient decompensate in front of you in the office. I was told the thing to do is you have to call the police, and have them deal with it. The police will get there in about 10 minutes--in which case you're going to have to fend for yourself.

Another thing I'm considering doing is keeping my name off any public lists such as white pages, and other sources of info such as a utility bill. I haven't had one yet, but the thought of a paranoid patient finding out where I live isn't exactly comforting. Some residents I know consider this overkill and paranoid, but I don't. I have friends who were the victims of stalkers and certain antisocial people. It causes no one harm while affording you a layer of extra protection so why not?

 

[DazedMD]

I have never felt scared in the hospital. The security in my hospital is great. They're there in seconds. The staff can tell when a patient will get out of line before it happens.

The danger situation depends on the hospital. The same hospital for example, from what I was told-the security was not so safe about 10 years ago. If a patient got out of line, 1 security guard would show up several minutes later who was an old man. Now they show up almost immediately--a bunch of burly 6 foot guys surround the patient immediately.

Outpatient--I never had a problem yet but the thought did cross my mind that at some point you might get a patient decompensate in front of you in the office. I was told the thing to do is you have to call the police, and have them deal with it. The police will get there in about 10 minutes--in which case you're going to have to fend for yourself.

Another thing I'm considering doing is keeping my name off any public lists such as white pages, and other sources of info such as a utility bill. I haven't had one yet, but the thought of a paranoid patient finding out where I live isn't exactly comforting. Some residents I know consider this overkill and paranoid, but I don't. I have friends who were the victims of stalkers and certain antisocial people. It causes no one harm while affording you a layer of extra protection so why not?

Is it possible to tailor your practice after residency to the extreme. For instance, I would like a practice where I do mainly psychotherapy, all women patients, depressed, anxious, eating disorders, no psychotics.

Can I do this and may a good salary?

 

[fiatslug]

Is it possible to tailor your practice after residency to the extreme. For instance, I would like a practice where I do mainly psychotherapy, all women patients, depressed, anxious, eating disorders, no psychotics.

Can I do this and may a good salary?

If you live in an urban environment where you can expect to find "the worried, wealthy well," then yeah, that's definitely possible, though in early career you might not be able to be as selective as you like.

And you might find a roster full of the patients you've described is quite fatiguing... 😉 Sounds like you will have an Axis II practice!

 

[fiatslug]

More on Dr. Fenton's murder follows. Now here's a question for the residents out there: do you feel like your program has taken adequate safety measures to protect YOU? We just got into a discussion about this in our clinic meeting, and we were a little pissed off at the blase attitude our clinic director seems to take to our safety. It's one of those things where if something happened to one of us, and the junior associate from Jacoby & Meyers successfully sued the incredibly deep pockets of our hospital, they'd somehow find a way to put panic buttons in the rooms wired to security, hire an additional receptionist who's actually here when we're seeing patients, etc--but for now, telling us to "excuse ourselves from the room" when we're being attacked seems to be the best defense our residency can offer us. 😡 😡 😡 😡



Suspect Wasn't Violent, Father Says
Teen Accused of Killing Psychiatrist Is Mentally Ill, Attorney Says

By Ernesto Londoño
Washington Post Staff Writer
Wednesday, September 6, 2006; Page B01

The 19-year-old North Potomac man accused of fatally beating a prominent doctor had been under psychiatric care for about six months but had not
acted violently before, his father said yesterday.

Albert Davydov said his family has "huge gratitude" for slain psychiatrist
Wayne S. Fenton, who had agreed to treat his son, Vitali. Fenton went "above
and beyond what he was supposed to do," Davydov said, adding that he wished
there was something he could do to help the psychiatrist's mourning family.

Barry Helfand, attorney for Vitali Davydov, talks to the media with
Davydov's parents, Natalia and Albert. Davydov is charged with first-degree
murder. (By Melina Mara -- The Washington Post)

Vitali A. Davydov is charged with first-degree murder in the killing of
Fenton, 53, who was beaten to death Sunday during a hastily arranged
appointment at which he tried to persuade the teenager to take his
medication for schizophrenia.

The teenager, dressed in a green prison jumpsuit, appeared yesterday via
closed-circuit camera from the county's main jail before Montgomery County
District Court Judge Gary L. Crawford, who ordered Davydov held without
bond. Toward the end of the bond hearing, while talking to his attorney over
the phone, Vitali Davydov was overheard saying, "My father did it."

Barry Helfand, the teenager's attorney, dismissed that claim. He said his
client is severely mentally ill and is "unable to appreciate where he is and
what's going on."

Authorities have provided few details about what might have triggered the
assault. Douglas Olson, 64, who lives near the crime scene, said Albert
Davydov, to whom he spoke at length while the two waited to give statements
to police, told him that his son had irrational delusions of being raped.

Helfand confirmed last night that the threat of rape "has been one of his
delusions" and that Davydov brought it up after being arrested.

Albert Davydov and his wife, Natalia, sat quietly in the front row of the
courtroom.

Helfand agreed with prosecutors that Davydov needs to be screened by mental
health experts. He will likely be evaluated at Clifton T. Perkins Hospital
Center, a state facility in Jessup where inmates are examined to determine
whether they are competent to stand trial. That could take a few weeks.

If Davydov is found competent to stand trial, Helfand said, he intends to
enter a plea of not criminally responsible due to mental illness.

Helfand said he is also assessing the possibility of finding a private
psychiatric facility where Davydov could be held while he is evaluated.
Helfand said the county jail might not be the most suitable place to provide
Davydov with the treatment he needs.

Assistant State's Attorney Constantine Lizas said Montgomery prosecutors
would oppose that option because releasing Davydov from jail would pose a
threat to the community.

Davydov allegedly told detectives that he killed Fenton on Sunday afternoon
by beating him with his fists at the doctor's office in Bethesda. Police
said Davydov had argued with his father over the medication he had been
prescribed for what police described as "schizophrenia/bipolar disorder" in
a charging document.

Fenton, a highly regarded psychiatrist who had served as associate director
of the National Institute of Mental Health, had agreed to see Davydov at 4
p.m. Sunday and told the teenager's father that he was going to try to
persuade Davydov to take the medication and perhaps accept an injected dose.

Albert Davydov said yesterday that his son had seen "quite a few"
psychiatrists in recent months but had not behaved aggressively.

Albert Davydov called police after finding his son outside Fenton's office
on Old Georgetown Road. He noticed blood on his son's hands, shirt and
pants, police said. He then saw Fenton lying on the floor inside a small,
rear office of a private medical building. The father was unable to enter
because the door was locked, he said, and he shattered a window with a rock.
Moments later, paramedics arrived and broke down the door.

Vitali Davydov was charged in December with possession of marijuana and
carrying a concealed dangerous weapon after a traffic stop in Montgomery
Village. Those charges were dropped.

Staff writer Cameron W. Barr contributed to this report.

 

[Anasazi23]

Insist that your residency director take the appropriate measures to have a safety and defense class, and install panic buttons at a minimum. The psychiatry defense class helps the team members work as a unit to help restraing and control dangerous situations. Otherwise people are just running around with chaos. If you get hurt and it is documented that your concerns for safety failed to be addressed, they can be held liable.