Safety of Psychiatry?

[BackToday]

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I'm a med student who's interested in Psychiatry, I'm hesitant to ask my attendings about the safety of the field, mainly because they work inpatient and I plan on working outpatient, and I'm not sure how different the patient population is, and I'm thinking child psych. How safe is Psychiatry based on all of your experiences? Thanks for any help.

 

[Shikima]

Define safety.

 

[BackToday]

Define safety.

I guess I should ask, how often in your practice are you genuinely fearful for your physical safety, or your family's safety.

 

[birchswing]

.

 

[BackToday]

It sounds like you're concerned that the DEA agents will forcefully raid your practice. Just don't be a criminal and you won't have to worry.

Not at all. I was talking about the safety of psychiatric patients in an outpatient setting, particularly in child psychiatry. That's what my previous question was about.

 

[SomeDoc]

I'm a med student who's interested in Psychiatry, I'm hesitant to ask my attendings about the safety of the field, mainly because they work inpatient and I plan on working outpatient, and I'm not sure how different the patient population is, and I'm thinking child psych. How safe is Psychiatry based on all of your experiences? Thanks for any help.

Psychiatrists are stalked the most by patients among the specialties, often stemming from patients' erotic transferences. Second on the list are surgeons and ob/gyns (particularly male).

In terms of risk of being assaulted, psychiatry's range is quite variable. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444180/

 

[birchswing]

.

 

[BackToday]

Psychiatrists are stalked the most by patients among the specialties, often stemming from patients' erotic transferences. Second on the list are surgeons and ob/gyns (particularly male).

In terms of risk of being assaulted, psychiatry's range is quite variable. See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444180/

Thanks for the study. It seems like no one who's interested in Psych every brings this up, or any attending that I've worked with (though most have been child psych), so what do I know?

 

[hamstergang]

I'm not a psychiatrist, as you can see
<-----

You're right, and so you don't have the right perspective to answer this question and you're not even citing research that actually answers this question. You instead chose to answer another question that no one asked. Why can't you leave threads to the topics they're actually about instead of steering them to the opinion you want to express as a non-psychiatrist? I have nothing against you having these conversations, but this isn't the forum for that.

 

[birchswing]

.

 

[hamstergang]

I guess I should ask, how often in your practice are you genuinely fearful for your physical safety, or your family's safety.

I'm a PGY-5 child/adolescent fellow and have never been afraid.

 

[birchswing]

You're right, and so you don't have the right perspective to answer this question and you're not even citing research that actually answers this question. You instead chose to answer another question that no one asked. Why can't you leave threads to the topics they're actually about instead of steering them to the opinion you want to express as a non-psychiatrist? I have nothing against you having these conversations, but this isn't the forum for that.

I agree in this instance. Bad joke. Not helpful.

 

[HarryMTieboutMD]

To the original poster... I guarantee that as a psychiatrist (or at least in a residency in an academic medical center) you will have a bigger problem with patients who don't follow your instructions/are non compliant/miss appointments than those who are overly intrusive and are actually going to take violent action against you or stalk you. And most psych patients are more liable to be victims of violence than the aggressors.

And for being attacked in person by a violent patient (like in the ED or inpatient unit), you just use your judgment. Always look over your shoulder, sit close to the door, use the staff when appropriate, etc.

None of my co residents or attendings worry about this.

 

[F0nzie]

It's a good question. The risk in child psych is very low especially in an outpatient setting. Family is an added protective factor. A little kid kicked me in the shin in the ER once but that is about it.

 

[downwithDTB]

Thanks for the study. It seems like no one who's interested in Psych every brings this up, or any attending that I've worked with (though most have been child psych), so what do I know?

There is actually surprisingly little research into the occupation related morbidity and mortality of physicians. I remember a study somewhere showing that psychiatrists have the highest rate of occupation related traumatic injury/death of all physicians; however, there is almost no data on occupation acquired infectious illness (save the real bad ones HIV, Hep C, etc.) for health care workers. I'd hypothesize that psychiatrists who work with adolescents and order have a slightly higher rate of trauma and a lower rate of occupationally acquired infectious M&M.

The reason that this isn't discussed with budding psychiatrists is likely: 1) the rate of serious injury is very low 2) there is a machismo culture in medicine where risk to physician is considered secondary. Rarely do specialties talk about actual risks beyond the "what to do if there is a needle stick" chat, which often includes a clinical student who was stuck saying "that was scary but now I'm fine! It's cool because patient's first and I'm macho!" Long story short, we just don't talk about personal risks in medicine. Psychiatry may have certain slightly less negligible risks than other specialties, but those could be weighed against infectious, radiation and well being risks if anyone would/could study them.

 

[FlowRate]

Just carry a gun and everything will be fine /trolling #notthatthreadagain

 

[Ψ-117]

In my limited experience, I have found adult inpatient settings to convey the highest risk of getting assaulted. I've had a couple of adult patients threaten to harm me but they didn't actually do anything to me. However, a couple of my fellow residents did get harmed by patients; one of them suffered a shoulder dislocation. I've never had a kid threaten to hurt me, though I did have a young autistic boy in clinic gently hit me a few times during a tantrum he was having in the middle of our interview. I feel bad for the nurses and psych techs on inpatient units because they're usually on the front lines when it comes to violent patients.

 

[nitemagi]

Anecdotally I've heard child forensics is the most dangerous. Don't take away people's kids, they might take it personally.

 

[PikminOC]

I have been afraid in my office. Its very different from residency when you are a solo doc and anything can walk thru the door. I'm trying to get better at screening. I did have one stalker. Police took care of it.

 

[nexus73]

I've been concerned after putting suicidal patients with antisocial personality disorder on holds. They are not your friend after that.

 

[BackToday]

I have been afraid in my office. Its very different from residency when you are a solo doc and anything can walk thru the door. I'm trying to get better at screening. I did have one stalker. Police took care of it.

How do you deal with something like that? Not necessarily being comfortable with who your next patient is going to be. I'm interested in Psych, I really think I could be great at it, particularly child psych, but for the last few days, this has just been on my mind. Am I making too much out of this? No attending or resident I talk to ever brings this up. Everything I read is about how rare this is, but then you read that 60% of residents are getting attacked, and you're like, "that doesn't sound rare."

 

[nitemagi]

You're not putting people on holds in your private office. Most do it in a hospital, with security.

 

[Leo Aquarius]

My office has a panic button. Never have had to use it, but they figure with this population you'd better have one just in case.

You'll be verbally abused in the Psych ER. That's one you can count on. Inpatient unit? Maybe. Outpatient? You'll get a sense if someone's mad at you when you talk to them on the phone to set up the appointment.

 

[Doctor Bagel]

I don't feel less safe in inpatient because there are always people around to help you out. I also don't go in and see the scarier people by myself and am pretty quick to get the hell out of there if it starts to feel iffy. Inpatient really can be dangerous for nurses and techs, but I think psychiatrists are lucky in that we can keep ourselves away from the dangerous stuff. In outpatient you're all alone in an office with someone.

 

[OldPsychDoc]

My brother-in-law is a small town banker. He probably is at more risk from his unhappy clientele than I am.

 

[DD214_DOC]

I've had patients (adults) try to threaten and intimidate me, but unfortunately for them my personality keeps me pretty immune to such things. I have had a couple female patients in long-term therapy track me down and randomly call my cell at 2AM, drunk and propositioning me. It was more awkward than anything.

Unless someone's completely psychotic, nearly everyone will back off if an attempt at intimidating another person fails to elicit the expected response. It's a natural reaction, because the underlying assumption is that there must be a very good reason why that other person wasn't intimidated, and discovering that reason is an unknown risk.

 

[MLT2MT2DO]

I'm a med student who's interested in Psychiatry, I'm hesitant to ask my attendings about the safety of the field, mainly because they work inpatient and I plan on working outpatient, and I'm not sure how different the patient population is, and I'm thinking child psych. How safe is Psychiatry based on all of your experiences? Thanks for any help.

As mentioned except for a few instances fairly safe. On inpatient you should normally have security and measures in place to insure safety. As outpatient your patients generally aren't so sick they don't know boundaries (of course this is also dependant on your patient population).

Personally when my wife was a public school teacher I worried more about her safety

 

[Ceke2002]

I know someone my Psychiatrist knew (a fellow Psych) who had a patient turn up on their doorstep late one evening and start threatening this person's family. The more sensationalistic stuff aside (the very rare stuff that the media jumps all over) that's probably the worst incident I've heard of. Apart from that, at least for my Psychiatrist and how much I'm privy too, it's more just having to pull patients back into line every so often when they over step boundaries*, and occasionally having to de-escalate situations in outpatients with bipolar patients becoming verbally aggressive. Again as far as I know the majority of physical violence is more of a risk inpatient, or in the ED, and they have security to do take downs if anything like that happens. The CMHC he works at for outpatient clients also has security in place if anything were to get out of hand.

(* For example emailing between appointments is a privilege afforded only after a patient has been in treatment for several months and appears to be able to handle said privilege without going into 'boundaries, what boundaries?' mode. Unfortunately it seems a small number of patients appear to start off with good intentions, and within a couple of weeks there's umpteen dozen emails coming across his computer every day with such vitally important questions and totally necessary information, like 'What are you doing?', 'Do you miss me?', 'I was just sitting here thinking about you and thought I'd send my eleventy hundreth email for the day' (etc etc). Yeah it's a privilege that can be provoked as quickly as it's given. 😎)

 

[MacDonaldTriad]

I read that the most likely place to get hit is an inpatient adolescent unit. I'm guessing a geri unit is second. Outpatient is an order of magnitude safer, but can have zero back up protection so it depends highly on the set up. Truthfully, if someone is truly after you, most precautions fail. Your best protection is observation and awareness.

 

[Ceke2002]

I read that the most likely place to get hit is an inpatient adolescent unit. I'm guessing a geri unit is second. Outpatient is an order of magnitude safer, but can have zero back up protection so it depends highly on the set up. Truthfully, if someone is truly after you, most precautions fail. Your best protection is observation and awareness.

My husband's late Grandfather was a Psychiatric Nurse at Glenside (State Psychiatric) Hospital in South Australia back in the 1950's. He had some interesting tales to tell, including the fact that one of the most dangerous patients there was a sweet looking little old lady in her eighties, who looked like a strong breeze could knock her over until she started snapping people's forearms (locked high security geriatric ward).

 

[MacDonaldTriad]

Dissinhibition and a loss of social awareness is much more dangerous than youth and strength. I'm guessing trauma doctors could be in more danger than we are.

 

[deleted343839]

I know an adult psychiatrist who was stalked to an extreme degree (ie, culminating in a home invasion) and several psychologists who have experienced a minor assault (eg, slapping/kicking) in inpatient settings. It can happen to anyone, but outpatient child psych is generally pretty safe.

I agree that nurses, techs, and other front-line staff have it worse. Incidentally, the most threatened I ever felt working in health care was during my stint as an ER admitting clerk in college.

 

[F0nzie]

The best advice I have for safety is be aware of perceived injustices. I have learned through experience working with a high risk adult population that an accumulation of perceived injustices is a risk factor for violence, particularly if there is a history of it. If you observe progressive hostility directed towards you in your encounters despite your best efforts to resolve the conflict, it is best to refer them out for your own safety. Antisocials that are argumentative and violent need to be passed on in order to be diffused. The docs that do not pass fast enough get burned.

 

[WisNeuro]

If you're antsy about safety at all, may want to stay away from forensic type situations. Most of my psychology/psychiatry colleagues never really get threatened or have significant safety concerns, with the exception of those that do forensic type work. I've been threatened a few times, usually after delivering the failed validity feedback to someone angling for compensation, but I don't think I've ever genuinely been afraid. May be some false sense of confidence due to being over 6 foot and in decent shape, who knows.

 

[DuskPhilosophy]

May be some false sense of confidence due to being over 6 foot and in decent shape, who knows.

Perhaps I should bulk up s little before intern year starts... GOMAD diet here I come!

 

[keifernny2]

It seems like there is a distinction between physical safety due to violent/aggressive behaviors and premeditated stalking/murder. I have not heard of any inpatient psychiatrists being murdered by patients on the unit, though violence / hitting / biting is common.

I have heard of a number of outpatient psychiatrists (including one I knew personally ) being murdered at their home by former patients and/or family members.

This is a touchy subject in our profession, and is something that with technology the way it is, there is no reason that every mental health professional shouldn't be given an office panic button and/or video monitoring of the clinic. This doesn't stop problems of stalkers tracking you from the office setting, however.

Interestingly, I was looking at houses the other day and the realtor can type your name and find your home address in public tax records immediately.

Does anyone here buy their home in a trust or Corp name to hide that info from inquisitive patients?


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[BackToday]

It seems like there is a distinction between physical safety due to violent/aggressive behaviors and premeditated stalking/murder. I have not heard of any inpatient psychiatrists being murdered by patients on the unit, though violence / hitting / biting is common.

I have heard of a number of outpatient psychiatrists (including one I knew personally ) being murdered at their home by former patients and/or family members.

This is a touchy subject in our profession, and is something that with technology the way it is, there is no reason that every mental health professional shouldn't be given an office panic button and/or video monitoring of the clinic. This doesn't stop problems of stalkers tracking you from the office setting, however.

Interestingly, I was looking at houses the other day and the realtor can type your name and find your home address in public tax records immediately.

Does anyone here buy their home in a trust or Corp name to hide that info from inquisitive patients?


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It's these kinds of things that unfortunately make me weary, and I hate admitting that. So many say it's rare, but then you hear about multiple psychiatrists being murdered. What kind of patient population were they dealing with?

 

[FlowRate]

Does anyone here buy their home in a trust or Corp name to hide that info from inquisitive patients?

I've read that advice, possibly on this forum, in the context of things to do when going into forensic practice.

 

[hamstergang]

It's these kinds of things that unfortunately make me weary, and I hate admitting that. So many say it's rare, but then you hear about multiple psychiatrists being murdered. What kind of patient population were they dealing with?

The question shouldn't be if any psychiatrists are killed by their patients, though. No matter what you do in life you're at risk of being killed by those you interact with regularly, and also those you don't. The question should be if psychiatrists are at greater risk than the general public, and if so by how much.

 

[MLT2MT2DO]

Perhaps I should bulk up s little before intern year starts... GOMAD diet here I come!

Once intern year hits and your getting free hospital food as well as stress eating you'll put on plenty of "bulk".

 

[notdeadyet]

How safe is Psychiatry based on all of your experiences?

Safety in psychiatry is largely based on experience, attentiveness, and environment.

Folks in outpatient practices largely treating anxiety and depression may have a solo practice with a panic button. Folks dealing with more axis II pathology and substance abuse may prefer to have a shared waiting room with other clinicians around as well. When you start dealing with more severe mental illness or acute units (like PES and inpatient units), there is often on on-site or stationed-nearby security guard in addition to multiple staffers trained in de-escalation.

Where you feel safest is largely a matter of personal preference. I would feel most exposed as a solo practitioner in some strip mall, but feel very comfortable with screaming patients in a PES, and most comfortable in a correctional setting. YMMV.

People will gravitate towards environments where they feel most comfortable. But the most important thing for safety is to make sure your environment takes appropriate care for safety and that you remain situationally aware and alert of your surroundings and the presentation of the person in front of you. Since a lot of this overlaps with delivering good care, it isn't hard to do.

 

[keifernny2]

Here's an article. http://www.psychiatrictimes.com/psy...nt-violence-against-health-care-professionals


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[Salpingo]

I'm a med student who's interested in Psychiatry, I'm hesitant to ask my attendings about the safety of the field, mainly because they work inpatient and I plan on working outpatient, and I'm not sure how different the patient population is, and I'm thinking child psych. How safe is Psychiatry based on all of your experiences? Thanks for any help.

1. Controlling for substance abuse, mental illness doesn't make someone more or less likely to commit a violent act (although they are more likely to be victims). Granted, that's an adult statistic.
2. Every specialty has some exposure to violent patients, especially if they're working in high volume or with people with substance use disorder (primarily ED physicians, but also psychiatrist). There was a story involving a surgeon in Boston earlier last year who was shot by a son of a deceased patient.
3. There's a good chance you will be assaulted at some point in a psych career, but you will also be surrounded by people trained to deescalate and manage the situation.
4. You will be better trained to observe the warning signs of violent behavior.

Bottom-line is, don't pick your specialty based on perceived safety (unless its radiology or pathology). People are inherently irrational and violent, whether or not they have mental illness, and any field involving working with a lot of sick people carries an inherent risk.

 

[nitemagi]

4. You will be better trained to observe the warning signs of violent behavior.

This is key. Including psychopaths who might not give warning signs, but you'll be better trained at identifying them than your colleagues.

Fear as a medical student comes from the apparent black box of psych. We fear what we don't understand. You can continue in ignorance and fear, or get educated (trained) and live a more informed life with minimal fear.

 

[calvnandhobbs68]

If you look at that psychiatric times article, the numbers aren't negligible for even internal medicine or surgery residents. Nurses and techs have very high rates of assault as well. People get mad at you in medicine. You many times are quite literally controlling the direction their lives will go and if it doesn't go the direction they want it to, they react strongly. They may blame you for problems they perceive to be under your control or for things you've done which they disagree with. It's not necessarily unique to psychiatry. Like @Salpingo said, better do radiology or pathology if you want no chance of encountering situations with frustrated/angry patients or their families who are looking for someone to blame and might turn violent.

 

[psych md jd]

If patients become verbally assaultive during a telepsych session I just turn down the volume, turn off my camera, and play fetch with my golden.

 

[Ceke2002]

If patients become verbally assaultive during a telepsych session I just turn down the volume, turn off my camera, and play fetch with my golden.

Um, Sorry? With your golden what? 😵 (<---- closely thing to a confused smiley I could think of).

 

[psych md jd]

retriever.

 

[Ceke2002]

retriever.

Oh, FFS, of course.

 

[BackToday]

It's funny. I don't know why this is a big deal all of a sudden to me. I did a Child Psych elective, and loved it. I really thought it was a field that I could make a real impact in. Kids with anxiety and depression, in particular. Then, I started wondering about safety concerns in this field, and I said I wouldn't look up data online, then I did. Now, it's really stuck on my mind. My biggest fear is just someone threatening my family. I can't imagine having kids of my own, and threatening them. Honestly, I just want to focus on kids with anxiety, depression, eating disorders, self-harm. I really want and think I can help them. I don't know why this is tripping me up so much.