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Psychiatry Dangerous
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I always carry live grenades with me.......just in case. You never know when you might have to explode your way out of a sticky situation.
Seriously though, I've found most patients to be very appreciative of psychiatrists.
Seriously though, I've found most patients to be very appreciative of psychiatrists.
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It does happen. As a psychiatrist your job is often to tell people what they don't want to hear.
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Can you get into a dangerous situation? Yes, if you start becoming too comfortable with psychiatry. Most of the time "doing the best you can for the patient" and "your safety" are not in conflict, but when they are, you need to be able to recognize it and value "your safety"..... I call it "Job Security". It's the reason psychiatry has wonderful work hours and a relaxed practice. After a while, it becomes second nature to you.
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Nothing has happened to me yet, and my patients are generally happy to see me.
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I'm going to separate this into 3 patient populations.
1) Outpatient: These are usually people who are stable but need a medication check and talk therapy every 4 weeks or more.
2) Inpatient, short term: these are people who become unstable (e.g. psychotic, suicidal, severely) and need inpatient hospitalization on the order of a few days to weeks.
3) Inpatient, long term and forensic psychiatry: These are people who are unstable and don't get better in a few weeks of treatment. Some of these people require several months, even years, and unfortunately may even require to be in inpatient for life (unless a new development can help them).
I'm dividing it into 3 poles. Obviously there will be people who don't cleanly fit into a category.
Category 1 & 2, you usually don't have to worry about it except while on the job. If your workplace has the proper safeguards in place, then you won't have to worry about it much either so long as you follow the proper safeguards.
The proper safeguards? for 1-emergency panic buttons that will alert the police or the staff to the police, staff will warn you ahead of time if they think the patient is unstable etc.
For 2-security that will respond in seconds, PRN medications in place, the facility needs to have the proper safeguards (e.g. no sharp objects) etc.
Now #3 is a separate category altogether. If someone is transferred to a long term facility, these people are usually in a category of higher dangerousness. I can tell you from personal experience that I have not had any problems in this area so far. I've worked with patients and done evaluations on people found not guilty by reason of insanity for violent crimes.
Of course, I do practice some common sense privacy. I don't give out my private information to anyone. If someone needs my phone number, I give them my work number. I don't put my personal information on the internet except for facebook, and that is set up so that only friends can see it.
For #3, most people who are mentally ill to the point where they want to harm others are not mentally stable enough to remember you to the point where they will hold a grudge.
In one specific model, there's 2 types that people that commit violence. They are predators (pre-planned violence, e.g. they stalked the person for several days, planned out the violent act, bought weapons and equipment for the task) or people who did a violent act due to a reaction, e.g. someone who attacks someone because they thought the other person was a demon, or they did it in self defense.
The predators are the people you have to worry about after you go home. You, however, will most likely not be in a situation where you have a predator specifically against you. Most psychiatrists will never have one of these types upset against them for their entire career. That is even in regards to a forensic psychiatrist. Even in those situations, the predator sees you as only a part of the process. They are more likely to stay mad at the prosecutor since the prosecutor is the one who remains against him or her during the entire trial.
As for the people who do violence in the form of a non-planned reaction, you don't have to worry about them except on the job. Like I said, if the place you work at is properly equipped, then you'll be fine so long as you follow common sense and follow your training.
1) Outpatient: These are usually people who are stable but need a medication check and talk therapy every 4 weeks or more.
2) Inpatient, short term: these are people who become unstable (e.g. psychotic, suicidal, severely) and need inpatient hospitalization on the order of a few days to weeks.
3) Inpatient, long term and forensic psychiatry: These are people who are unstable and don't get better in a few weeks of treatment. Some of these people require several months, even years, and unfortunately may even require to be in inpatient for life (unless a new development can help them).
I'm dividing it into 3 poles. Obviously there will be people who don't cleanly fit into a category.
Category 1 & 2, you usually don't have to worry about it except while on the job. If your workplace has the proper safeguards in place, then you won't have to worry about it much either so long as you follow the proper safeguards.
The proper safeguards? for 1-emergency panic buttons that will alert the police or the staff to the police, staff will warn you ahead of time if they think the patient is unstable etc.
For 2-security that will respond in seconds, PRN medications in place, the facility needs to have the proper safeguards (e.g. no sharp objects) etc.
Now #3 is a separate category altogether. If someone is transferred to a long term facility, these people are usually in a category of higher dangerousness. I can tell you from personal experience that I have not had any problems in this area so far. I've worked with patients and done evaluations on people found not guilty by reason of insanity for violent crimes.
Of course, I do practice some common sense privacy. I don't give out my private information to anyone. If someone needs my phone number, I give them my work number. I don't put my personal information on the internet except for facebook, and that is set up so that only friends can see it.
For #3, most people who are mentally ill to the point where they want to harm others are not mentally stable enough to remember you to the point where they will hold a grudge.
In one specific model, there's 2 types that people that commit violence. They are predators (pre-planned violence, e.g. they stalked the person for several days, planned out the violent act, bought weapons and equipment for the task) or people who did a violent act due to a reaction, e.g. someone who attacks someone because they thought the other person was a demon, or they did it in self defense.
The predators are the people you have to worry about after you go home. You, however, will most likely not be in a situation where you have a predator specifically against you. Most psychiatrists will never have one of these types upset against them for their entire career. That is even in regards to a forensic psychiatrist. Even in those situations, the predator sees you as only a part of the process. They are more likely to stay mad at the prosecutor since the prosecutor is the one who remains against him or her during the entire trial.
As for the people who do violence in the form of a non-planned reaction, you don't have to worry about them except on the job. Like I said, if the place you work at is properly equipped, then you'll be fine so long as you follow common sense and follow your training.
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My understanding is that statistically, no, psychiatry is not a dangerous specialty, or even more dangerous than other specialties. But, yeah, we've all heard stories or been in situations where things could be a little dicey. I met 2 residents who had been punched by patients (however, I think one of the patients was a general IM patient). One of the attendings at my school is very adamant that psychiatrists who get attacked usually could have prevented it by not going into dangerous situations and by actually leaving if a patient tells you to go. I think there's some truth there. Overall, though, the despite stigma and all that, the vast majority of psych patients are not violent, and any physician who has contact with patients runs the risk of dealing with someone who could be violent.
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It's true that there are cases of psychiatrists (and other mental health workers) being attacked or even killed by patients.
This case was in the news a few years back: http://pn.psychiatryonline.org/content/41/19/1.1.full
You should not be complacent about the risk or assume that you can prevent every patient from lashing out. All you can do is try to anticipate the risk and take precautions.
Pretty much every specialty has some sort of hazard associated with it. For example, many other specialties have a much higher risk of a needlestick injury, being exposed to radiation, being exposed to infectious disease, etc. than a psychiatrist would. Incidentally, I've heard that healthcare worker assaults are most likely to occur from elderly dementia patients (even though many people might not expect the little old lady with dementia to be as much of a threat as a young man with a psychosis). That's a patient population that most doctors and nurses will have to interact with at some point.
This case was in the news a few years back: http://pn.psychiatryonline.org/content/41/19/1.1.full
You should not be complacent about the risk or assume that you can prevent every patient from lashing out. All you can do is try to anticipate the risk and take precautions.
Pretty much every specialty has some sort of hazard associated with it. For example, many other specialties have a much higher risk of a needlestick injury, being exposed to radiation, being exposed to infectious disease, etc. than a psychiatrist would. Incidentally, I've heard that healthcare worker assaults are most likely to occur from elderly dementia patients (even though many people might not expect the little old lady with dementia to be as much of a threat as a young man with a psychosis). That's a patient population that most doctors and nurses will have to interact with at some point.
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Is it fair to say child and adolescent has the lowest risk of homicide and forensics and psychosomatic medicine the highest risk. Perhaps geriatric and addiction in the middle. Any thoughts on the subspecialties of Psych. Thank you for your help and insight.
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I'm not sure any good studies have been done to evaluate this across the nation. Any advise here would be pure speculation.
I'm not sure psychiatrists are any more likely than any other type of physician to be shot at....or anything else.
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Geriatric psychiatry, with the sweet little old ladies who suddenly reach up and pull your hair.....🙂
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I should correct myself and say I was attacked--in fact punched in the face.
In reality almost any aspect of medicine can run a risk of danger. A buddy of mine, his father is an Ob-Gyn doctor. He delivered a baby that later died of complications. The father of the baby attacked my father's (correction, friend's) dad with an Uzi that was converted to full automatic while on the highway. My buddy's dad is fine, but I think you get the point.
If you go into medicine, you could accidently nick yourself with an HIV infected needle.
Psychiatry IMHO does not put you in any significantly higher level of danger so long as you follow the proper safeguards. If for example someone gets agitated on the unit, its the orderlies, campus security and the nurses who have to handle it physically. All you have to do is sign the orders.
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It varies greatly by hospital. Where I'm doing my residency doctors (residents in particular, attendings too) are usually the man handlers in restraining a patient. Hospital police gets there in 10-15 minutes after they are called (have to take elevators - always a pain, you can wait up to 15 minutes- and go through a double door system). Nurses and techs are mostly petite women who are the first to disappear when situation escalades.
Some of my colleagues have been hit by patients on inpatient service, fortunately none too serious a few fat lips and black eyes. We do take self defense classes and crisis prevention lectures provided by hospital. Comes with the job 🙂.
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No real surprise that our emergency psych unit has the most assaults, since that's where people are the most untreated, the most acutely intoxicated or withdrawing, and that's where they get the bad news that they're staying in the hospital (or sometimes it's the bad news that they have to go).
All our doctors will help with the actual physical restraint, but most are not really trained/talented in the physical intervention, so they are rarely the first to be hands-on. However, we happen to have a few docs who are very well-trained and effective in that as well. In most places, the nursing staff will be very happy if you just provide restraint and/or medication orders quickly.
Take the training seriously, take it every time it's offered, and pay attention to those who do it well. Do everything you can to avoid confrontations in enclosed area. Do NOT get into tests of will. Quickly end conversations once they have gotten into a power struggle.
All these things are true for ANY field.
Ultimately, you are probably at far greater risk of serious injury driving to work and driving home again than in most any position as a psychiatrist.
All our doctors will help with the actual physical restraint, but most are not really trained/talented in the physical intervention, so they are rarely the first to be hands-on. However, we happen to have a few docs who are very well-trained and effective in that as well. In most places, the nursing staff will be very happy if you just provide restraint and/or medication orders quickly.
Take the training seriously, take it every time it's offered, and pay attention to those who do it well. Do everything you can to avoid confrontations in enclosed area. Do NOT get into tests of will. Quickly end conversations once they have gotten into a power struggle.
All these things are true for ANY field.
Ultimately, you are probably at far greater risk of serious injury driving to work and driving home again than in most any position as a psychiatrist.
Find that hard 2 believe with u being such a charmer
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I read a study indicating 40% of psych residents were assaulted at some point in their training (older study, Canadian, I think). Not sure if they were using the legal definition (no physical contact) or layman's definition (synonymous with battery).
Not sure if it was from the same study, but 75% of those assaults came from first-time encounters with patients. Not sure about the takeaway from that. Quickly introduce yourself to iffy patients then return a few minutes later?
Not sure if it was from the same study, but 75% of those assaults came from first-time encounters with patients. Not sure about the takeaway from that. Quickly introduce yourself to iffy patients then return a few minutes later?
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At one of the psych programs I rotated at the thinking was "What kind of message are you sending to the nurses and other psych staff if you run and hide when a patient gets agitated?". The doctor was expected to be there helping them to deal with it as the "leader of the team".
And don't be the psychiatrist who gets caught up in trying to argue with a delusional patient about why their delusions aren't true (yes, I have seen that kind of thing happen).
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I don't know the situation where you are, but this does not sound safe. I've worked in over 10 psychiatric hospitals so far (and I admit 5 of them only on a consult basis for the court so I'm only there once every 2 weeks for about an hour). 2 of those hospitals had forensic units that housed people who killed others.
At each hospital, security showed up in seconds.
Further, several in the field, and this is mentioned in K&S, criticize the idea of a psychiatrist physically handling patients.
I do think a psychiatrist needs to make his or her presence as a group leader on the unit. That includes being there for your treatment team when a situation such as placing restraints. However if it takes that long for security to show up, and getting attacked is the expected norm, I'd consider that program on the much more dangerous side, and that program should take more action to keep it's employees safe.
I have seen some psychiatrists almost never present on their unit, and just phone in orders. That IMHO is poor practice. You are not going to understand the dynamics of what is going on your unit unless you spend a few hours a day on that unit, and listen to the input of your treatment team.
At every hospital I've seen, and the crisis training supports this, if a patient becomes agitated, the staff should surround that patient, while keeping a safe distance. Yes, if you are directly in front of the patient, you run away, but once everyone is alerted, the staff are supposed to surround the patient. This in effect ends up with the patient being surrounded by over 12 people in seconds.
If all the staff are running away--that is not a good thing.
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What kind of psychiatry is it you practice?
Lol no I am no psychiatrist I am just reading random forums u know not much going on at the surgery forums
But anyway happy new year to u all
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keep in mind that there is a risk you take whenever you sign up to work in many of the helping professions. I've been hit a couple of times at my job and I know it's the risk I take in working with the population (although I am not a psychiatrist). There are steps we can take to cut down on the likelihood of being injured on the job or being in a position of danger like you described above. Many places that offer jobs dealing with these types of situations provide extensive training to employees to cover their own liability.
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This really makes no sense at all
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This is becoming less and less common. Hospitals are getting in trouble with regulatory agencies for using police or security personnel in order to manage patients' behavior. Several California hospitals have gotten in huge trouble for this kind of thing. And I kind of understand this principle. Imagine if a major medical hospital instructed their nursing staff to not do CPR on Code Blue patients because that's really a specialty of EMS, "so just call 911 when that happens." To the regulatory agencies (and patients' families), that's analagous to calling security personnel to deal with psychiatric patients' behavior. To that end, the agencies are requiring that nursing staff manage patient behavior unless it involves something truly outside their capability (like if a pt pulls a knife or a gun). If the hospital is not hiring an appropriate mix of nursing staff (that does NOT mean hiring a load of large male "goons", but an appropriate mix), then that is the hospital's fault and their problem to solve.
In our hospital, those docs skilled at the physical intervention may be the first with hands-on, but those with less skill/experience are certainly willing to help but do not act as first-line.
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I remember one time in residency, a patient came into the outpatient office agitated. The staff didn't know what to do, so they grabbed me (then a PGY-III), and put the patient in an empty room, told me there was an emergency, put me in the room with the agitated patient, and then closed the door on me.
Those same staff then went to work as if there was nothing to worry about.
Well, it all ended up being fine, though it wasn't by design, it was by accident. The staff for all they knew could've been closing the door on me with a patient who was armed and wanting to kill. The agitated patient was having a PTSD reaction, not psychosis or mania. He wanted help. However, at the time, the staff and I couldn't tell, and he screamed quite a bit. It took me about 10 minutes to figure I was not in danger, and I didn't run out because I didn't know if running out was going to incite even more agitation.
It turned out the outpatient staff had no training whatsoever other than secretial training, and very little experience with agitated patients.
My PGY-I year, a senior resident had an agitated patient in outpatient, and the staff at that occurrence also did not know what to do. In that case, the patient was violent. The police showed up 15-20 minutes after the event.
(I mentioned this incidence a few years ago on the board. At the time a Geodon drug rep was there, freaked out, hid under a table, and kept begging the staff to get out some geodon to give to the patient).
IMHO, the facilities had very poor planning. An agitated patient in the outpatient office is rare, but it does occur to the point where you need to expect it to happen over the course of at least a few years. This was especially true for those offices, where several of the patients had a history of noncompliance and violence when psychotic.
I did bring this up as a complaint. What bugged me was I was the only resident complaining about it. I had 2 other residents in my location who were just the "keep quiet and don't complain" types. It also turned out that very few residents complained about this, so when I did complain, it made me stick out more.
I also directly told the staff that dumped me in the room that I thought their actions were not safe. They should've at least called 9-1-1. The responded that since I was a psychiatrist, they thought I had some type of magical "laying of hands" technique I could've used. They never saw an agitated patient and did not know that in a hospital setting, medication is used for patients who cannot be calmed down through verbal redirection.
While I thought their actions were just, ahem, a bit stupid, I did actually believe their honesty. These staff were not medical professionals. They were secretaries. I also got to know them better as time went by, and they always acted in good faith.
In any case, IMHO a facility needs to have a rock solid plan on how to deal with violence, even if it's an outpatient facility. Where I do moonlighting, there are panic buttons in all the offices, the staff already know exactly what to do if I press the button (call the police, go to the office to see if everyone is alright). In fact in one office, the panic button is directly linked to the police. If it goes off, and it's a false alarm, we have to call the police to tell them to it's alright. The local police also consider the office a high priority area for their regular beats.
Same goes for inpatient. A few years before I started residency, the involuntary unit was in a hospital where there was only one security guard, and a patient (who was extremely large, young and with a history of violence) became agitated. The security guard on duty that day was an elderly man who refused to hold the patient.
The police had to show up, and despite the mangement asking them not to bring their guns on the unit, did so (which violated state law, but who's going to arrest the police?). The police ended up letting a police dog loose on the patient who refused to yield. The attack dog, in a brilliant move (heck the dog was the only one doing anything right) went into an attack pose, barked loudly and showed his teeth which caused the patient to yield out of fear. The dog upon seeing the patient yield did not attack the patient. In fact it walked back to the police in a completely calm manner, and followed every order.
Thankfully the patient was not hurt, but I think everyone here get's the point. The hospital should've had a rock solid plan for violence, especially considering that the hospital had an ER and an involuntary unit. At least the hospital learned from that event and increased their security staff.
IMHO, not having a solid plan for violence in any psychiatric facility, even outpatient is pretty much inviting a future injury that could've otherwise been prevented. It's just a matter of time before it happens.
Those same staff then went to work as if there was nothing to worry about.
Well, it all ended up being fine, though it wasn't by design, it was by accident. The staff for all they knew could've been closing the door on me with a patient who was armed and wanting to kill. The agitated patient was having a PTSD reaction, not psychosis or mania. He wanted help. However, at the time, the staff and I couldn't tell, and he screamed quite a bit. It took me about 10 minutes to figure I was not in danger, and I didn't run out because I didn't know if running out was going to incite even more agitation.
It turned out the outpatient staff had no training whatsoever other than secretial training, and very little experience with agitated patients.
My PGY-I year, a senior resident had an agitated patient in outpatient, and the staff at that occurrence also did not know what to do. In that case, the patient was violent. The police showed up 15-20 minutes after the event.
(I mentioned this incidence a few years ago on the board. At the time a Geodon drug rep was there, freaked out, hid under a table, and kept begging the staff to get out some geodon to give to the patient).
IMHO, the facilities had very poor planning. An agitated patient in the outpatient office is rare, but it does occur to the point where you need to expect it to happen over the course of at least a few years. This was especially true for those offices, where several of the patients had a history of noncompliance and violence when psychotic.
I did bring this up as a complaint. What bugged me was I was the only resident complaining about it. I had 2 other residents in my location who were just the "keep quiet and don't complain" types. It also turned out that very few residents complained about this, so when I did complain, it made me stick out more.
I also directly told the staff that dumped me in the room that I thought their actions were not safe. They should've at least called 9-1-1. The responded that since I was a psychiatrist, they thought I had some type of magical "laying of hands" technique I could've used. They never saw an agitated patient and did not know that in a hospital setting, medication is used for patients who cannot be calmed down through verbal redirection.
While I thought their actions were just, ahem, a bit stupid, I did actually believe their honesty. These staff were not medical professionals. They were secretaries. I also got to know them better as time went by, and they always acted in good faith.
In any case, IMHO a facility needs to have a rock solid plan on how to deal with violence, even if it's an outpatient facility. Where I do moonlighting, there are panic buttons in all the offices, the staff already know exactly what to do if I press the button (call the police, go to the office to see if everyone is alright). In fact in one office, the panic button is directly linked to the police. If it goes off, and it's a false alarm, we have to call the police to tell them to it's alright. The local police also consider the office a high priority area for their regular beats.
Same goes for inpatient. A few years before I started residency, the involuntary unit was in a hospital where there was only one security guard, and a patient (who was extremely large, young and with a history of violence) became agitated. The security guard on duty that day was an elderly man who refused to hold the patient.
The police had to show up, and despite the mangement asking them not to bring their guns on the unit, did so (which violated state law, but who's going to arrest the police?). The police ended up letting a police dog loose on the patient who refused to yield. The attack dog, in a brilliant move (heck the dog was the only one doing anything right) went into an attack pose, barked loudly and showed his teeth which caused the patient to yield out of fear. The dog upon seeing the patient yield did not attack the patient. In fact it walked back to the police in a completely calm manner, and followed every order.
Thankfully the patient was not hurt, but I think everyone here get's the point. The hospital should've had a rock solid plan for violence, especially considering that the hospital had an ER and an involuntary unit. At least the hospital learned from that event and increased their security staff.
IMHO, not having a solid plan for violence in any psychiatric facility, even outpatient is pretty much inviting a future injury that could've otherwise been prevented. It's just a matter of time before it happens.
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That last one scares me the most. I hope to never work in that kind of situation.
Is it wrong that I sort of enjoy this inevitable side to psych?
It's not that I want to get hurt, it's that never being able to fall asleep on your job seems interesting, even if you've been at it a million years. Some cunning loony could still pwn you unless you're always two steps ahead of them.
It's not that I want to get hurt, it's that never being able to fall asleep on your job seems interesting, even if you've been at it a million years. Some cunning loony could still pwn you unless you're always two steps ahead of them.
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While psychiatry certainly can be interesting and challenging, you sound like the type who might enjoy a more action-packed specialty like emergency medicine or something. I actually have seen a psychiatrist fall asleep while talking to a depressed patient with psychomotor ******ation.
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I suspect ER is probably more dangerous than psychiatry.
Whenever you get an acutely violent patient due to mental illness---where do they get sent first? TO THE ER!
They aren't medicated when the first enter the ER. By the time you see them, they've sat in the ER for at least a few hours, so by then they either calmed down, have some reservation or were already medicated due to agitation.
And ironically, in the few state run psychiatric units I've seen, the forensic units were the safest. Why? It wasn't because of the patients. The patients usually were more dangerous. It was because everyone knew they were dangerous, so the institution had several safeguards in place on those units that weren't in place in a typical psychiatric unit.
Whenever you get an acutely violent patient due to mental illness---where do they get sent first? TO THE ER!
They aren't medicated when the first enter the ER. By the time you see them, they've sat in the ER for at least a few hours, so by then they either calmed down, have some reservation or were already medicated due to agitation.
And ironically, in the few state run psychiatric units I've seen, the forensic units were the safest. Why? It wasn't because of the patients. The patients usually were more dangerous. It was because everyone knew they were dangerous, so the institution had several safeguards in place on those units that weren't in place in a typical psychiatric unit.
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In some places, like most of CA, such pts are usually brought directly to the psych emerg service. They only go to the ER if they were injured in the tussle with police.
I can barely fall asleep in my own bed!
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I have had a couple of instances happen to me.
Once a guy high on cocaine came in demanding ritalin and threw all the charts off the table after me telling him no.
Another time I almost got between a very large man and a wall. The wall had a painting the man didnt like and he rushed into it running full speed putting a large hole in it and ending up needing neurosurgery (the man, not the wall...the wall needed reconstructive surgery).
Both these things happened in my first 2 years of residency when I wasn't paying attention. The first time, I should have guessed he was high, the second I should have gotten a nursing report in the morning about how the patients are doing without just starting rounds on my own.
On the other hand, I have worked in a jail and a 2 forensics facilities without any problems.
So for me the moral is that psychotic people do crazy things. But when you are aware of this possbility, your chances of being in a dangerous situation decrease significantly.
Once a guy high on cocaine came in demanding ritalin and threw all the charts off the table after me telling him no.
Another time I almost got between a very large man and a wall. The wall had a painting the man didnt like and he rushed into it running full speed putting a large hole in it and ending up needing neurosurgery (the man, not the wall...the wall needed reconstructive surgery).
Both these things happened in my first 2 years of residency when I wasn't paying attention. The first time, I should have guessed he was high, the second I should have gotten a nursing report in the morning about how the patients are doing without just starting rounds on my own.
On the other hand, I have worked in a jail and a 2 forensics facilities without any problems.
So for me the moral is that psychotic people do crazy things. But when you are aware of this possbility, your chances of being in a dangerous situation decrease significantly.
