Safety of Psychiatry?

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BackToday said:
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.
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It's reasonable to think about, but the absolute risk of something bad happening is low. Just like it's unlikely that you'll get full blown TB if you stay in medicine... but you might... and you'll probably at least get exposed. Are you worried about a needle stick? Etc. The job isn't dangerous enough that you should really worry, but it's also not being a librarian in a quite suburb. Certainly unlikely that your family is targeted and something happens per every statistic. Also, although everyone here seems to think path is super safe, autopsies are anything but...
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I imagine the highest risk for assault for psychiatrists on the job is going to be inpatient, either ED, psych unit, or medical floor, where a patient is either so dysregulated or psychotic they've lost the ability to not attack you. No rationale person would attack a health care provider, what with it being a felony assault in most, if not all, states. These on the job situations are less scary to think about because there are so many people around, plus security, plus several other people have probably interacted with the patient before you, so you get a heads up prior to the interview the patient is on edge. Keep yourself between the patient and the door, or interview with the door open and at least 10 feet from the patient.

The more concerning worry in my mind is the patient who wants to find you when you're not working.
 
downwithDTB said:
It's reasonable to think about, but the absolute risk of something bad happening is low. Just like it's unlikely that you'll get full blown TB if you stay in medicine... but you might... and you'll probably at least get exposed. Are you worried about a needle stick? Etc. The job isn't dangerous enough that you should really worry, but it's also not being a librarian in a quite suburb. Certainly unlikely that your family is targeted and something happens per every statistic. Also, although everyone here seems to think path is super safe, autopsies are anything but...
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Also, rads can give you eyestrain. :D
 
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nitemagi said:
Also, rads can give you eyestrain. :D
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Rads is the perfect example of a specialty where the risk of a specialty used to be massive but people didn't even realize it until it was too late.
 
Imagine this scenario:

A patient hits your car, or you hit a patient's car. By law, you have to exchange license and insurance info.

Some states allow a PO Box on your driver's license, but usually require a physical address to be on file.

Likewise, insurance will allow a PO Box for a mailing address, but if your file gets transmitted to the other insurance company, your address may be disclosed.
 
nexus73 said:
I imagine the highest risk for assault for psychiatrists on the job is going to be inpatient, either ED, psych unit, or medical floor, where a patient is either so dysregulated or psychotic they've lost the ability to not attack you. No rationale person would attack a health care provider, what with it being a felony assault in most, if not all, states. These on the job situations are less scary to think about because there are so many people around, plus security, plus several other people have probably interacted with the patient before you, so you get a heads up prior to the interview the patient is on edge. Keep yourself between the patient and the door, or interview with the door open and at least 10 feet from the patient.

The more concerning worry in my mind is the patient who wants to find you when you're not working.
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You seem to be forgetting that you're working with psychiatry patients. Assuming rationality from the onset is not a smart thing to do....
 
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I'd always felt safe until my current gig. In my last job, I had a patient making vague homicidal threats against doctors of a particular ethnicity. He was discharged from the entire system and they distributed his picture to security and posted guards.

My current job is in a terrible neighborhood. So terrible that a woman was killed in a hit and run accident out front yesterday morning and all the patients coming in that morning who saw the tarp covered body said nonchalantly, "I guess there was a shooting this morning."

Security can be called and they are responsive. But there are no pull cords to call them. And building access is not restricted. People have come in off the street and wandered office to office selling candy bars.

Patients have come into my office uninvited to ask for controlled substances, to ask various questions, to complain about something, to demand to be seen. One of them locked the door behind him.

No one has actually threatened me or harmed me or shown any type of weapon. But they could. They totally could at any time.

The famous incident of the psychiatrist who pulled a gun and killed the patient who killed the social worker didn't happen here. But it happened not far from here. I don't have a gun. I don't know how to work one and would be more a danger to myself.

I guess my point is that in most places, you're going to be more or less safe. But asking questions about what measures are taken to ensure safety is a good thing to do during the interview process. Are there panic buttons? How responsive is security? Is access to the building restricted to be people who have a legitimate reason to be there? But this applies to all fields of medicine. There are other specialities located in this building that would be dealing with the same concerns.


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sunlioness said:
I'd always felt safe until my current gig. In my last job, I had a patient making vague homicidal threats against doctors of a particular ethnicity. He was discharged from the entire system and they distributed his picture to security and posted guards.

My current job is in a terrible neighborhood. So terrible that a woman was killed in a hit and run accident out front yesterday morning and all the patients coming in that morning who saw the tarp covered body said nonchalantly, "I guess there was a shooting this morning."

Security can be called and they are responsive. But there are no pull cords to call them. And building access is not restricted. People have come in off the street and wandered office to office selling candy bars.

Patients have come into my office uninvited to ask for controlled substances, to ask various questions, to complain about something, to demand to be seen. One of them locked the door behind him.

No one has actually threatened me or harmed me or shown any type of weapon. But they could. They totally could at any time.

The famous incident of the psychiatrist who pulled a gun and killed the patient who killed the social worker didn't happen here. But it happened not far from here. I don't have a gun. I don't know how to work one and would be more a danger to myself.

I guess my point is that in most places, you're going to be more or less safe. But asking questions about what measures are taken to ensure safety is a good thing to do during the interview process. Are there panic buttons? How responsive is security? Is access to the building restricted to be people who have a legitimate reason to be there? But this applies to all fields of medicine. There are other specialities located in this building that would be dealing with the same concerns.


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You need security call buttons in your office.
 
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F0nzie said:
Just in time to clean up the remains ;)
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Indeed. We've adapted a local response, if you're not busy, you go to the area as a show of force. Seems to work, really haven't had any critical incidents in quite some time. Although, fairly low base rate behavior in an outpatient setting to begin with.
 
A pt recently pulled a knife on my RN and she had no panic button. She deescalate him in her office and nobody even knew. Even if it takes 10 min for police to arrive, at least it could have alerted staff to get her out of the office.
 
I prefer screamers to call buttons if you are in a community health environment. Your odds are often better with coworkers doing a show of force than waiting for police to arrive.

They are also cheap and can be bought for staff without going through a prolonged budget/political morass.
 
All of my employees have an alarm.
My offices have camera surveillance/recording of the hallways and waiting areas.
All exterior doors and some interior doors require a keycard.
There is an electronic lock door from the waiting area to the clinical offices.
We have a safety officer responsible for evacuation plans and have drills a few times a year. Staff have a safe word.
And, I have considered bulletproof glass and steel plates in the wall of the reception area.

Better safe than sorry.
 
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notdeadyet said:
I prefer screamers to call buttons if you are in a community health environment. Your odds are often better with coworkers doing a show of force than waiting for police to arrive.

They are also cheap and can be bought for staff without going through a prolonged budget/political morass.
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Never heard of a screamer.... Product link?
 
psych md jd said:
All of my employees have an alarm.
My offices have camera surveillance/recording of the hallways and waiting areas.
All exterior doors and some interior doors require a keycard.
There is an electronic lock door from the waiting area to the clinical offices.
We have a safety officer responsible for evacuation plans and have drills a few times a year. Staff have a safe word.
And, I have considered bulletproof glass and steel plates in the wall of the reception area.

Better safe than sorry.
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You don't mess around....
 
I have a hard enough time firing a person for cause.

I can't imagine what it would feel like to notify the next of kin of an employee.
 
There really should be an osha safety standard for medical/mental health clinics with more than 5 employees, requiring door cams, panic buttons & electronic swipe locks, and multiple exits. That would be the only way to get large organizations (that otherwise don't care ) to comply.


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keifernny2 said:
There really should be an osha safety standard for medical/mental health clinics with more than 5 employees, requiring door cams, panic buttons & electronic swipe locks, and multiple exits. That would be the only way to get large organizations (that otherwise don't care ) to comply.


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Maybe, but that would be a huge infrastructure cost for small practices <10-15 people, including office staff and such.
 
WisNeuro said:
Maybe, but that would be a huge infrastructure cost for small practices <10-15 people, including office staff and such.
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Well yeah it'd be an infrastructure cost but I guess the whole point is do you value your co-workers lives over some cash for security cams, a few extra exits and electronic locks. The electronic locks would probably be the biggest cost sink, you can be a fairly sophisticated security camera system off the shelf for 1-2k with the ability to centrally wifi record everything to a hard drive. Extra exits are a cost but fixed, once they're built that's it. The door locks would likely require an ongoing contract or the ability to call in someone to repair them quickly.

@psych md jd would know more about the cost though since he's pimped out his office with all this
 
Hmmmm, it seems to go both ways based on this the replies in this thread. Some people are getting a lot of measures, while others don't seem to feel that they are as necessary.
 
I think it may bit a bit safer for docs, since you aren't really around the patient that much, but there was a nurse at the state hospital here who was stabbed by a 19 old female patient who got a piece of hard plastic and somehow made a shank.
 
Here is a memorable excerpt from an article on the issue:

Source: http://www.jaapl.org/content/41/2/200.full

Commentary: Stalking by Patients—Psychiatrists' Tales of Anger, Lust and Ignorance

Another female patient accused her psychiatrist of having sexual relations with her in his office during their psychotherapy sessions. The psychiatrist was mounting a vigorous defense until the patient brought to the local police dried semen from the psychiatrist that she stated had come from her underwear while having sex with him. Felony criminal charges were filed against the psychiatrist after DNA testing, and his license was in the process of being suspended. A rigorous investigation eventually revealed that she had stalked the psychiatrist's home subsequent to the termination of treatment and had found several pairs of his semen-stained underwear in his trash containers—he was on a weight loss program, and his wife was throwing away his excessively large underwear in their trash. When confronted by the police, the ex-patient admitted to stealing the underwear and scraping semen from it. The charges against the psychiatrist were dropped
 
psych md jd said:
All of my employees have an alarm.
My offices have camera surveillance/recording of the hallways and waiting areas.
All exterior doors and some interior doors require a keycard.
There is an electronic lock door from the waiting area to the clinical offices.
We have a safety officer responsible for evacuation plans and have drills a few times a year. Staff have a safe word.
And, I have considered bulletproof glass and steel plates in the wall of the reception area.

Better safe than sorry.
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The problem is when we are off work. Like someone listed above, people can easily find so many information of me and my family, simply by typing in my name in the Google search bar.

My plan so far: use a trust for my next house, get a PO box for APA and other professional stuffs.

Are we allowed to use a PO box for the state license, DEA license, NPI etc?
 
SomeDoc said:
Here is a memorable excerpt from an article on the issue:

Source: http://www.jaapl.org/content/41/2/200.full

Commentary: Stalking by Patients—Psychiatrists' Tales of Anger, Lust and Ignorance

Another female patient accused her psychiatrist of having sexual relations with her in his office during their psychotherapy sessions. The psychiatrist was mounting a vigorous defense until the patient brought to the local police dried semen from the psychiatrist that she stated had come from her underwear while having sex with him. Felony criminal charges were filed against the psychiatrist after DNA testing, and his license was in the process of being suspended. A rigorous investigation eventually revealed that she had stalked the psychiatrist's home subsequent to the termination of treatment and had found several pairs of his semen-stained underwear in his trash containers—he was on a weight loss program, and his wife was throwing away his excessively large underwear in their trash. When confronted by the police, the ex-patient admitted to stealing the underwear and scraping semen from it. The charges against the psychiatrist were dropped
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WOW!!!
 
SomeDoc said:
Here is a memorable excerpt from an article on the issue:

Source: http://www.jaapl.org/content/41/2/200.full

Commentary: Stalking by Patients—Psychiatrists' Tales of Anger, Lust and Ignorance

Another female patient accused her psychiatrist of having sexual relations with her in his office during their psychotherapy sessions. The psychiatrist was mounting a vigorous defense until the patient brought to the local police dried semen from the psychiatrist that she stated had come from her underwear while having sex with him. Felony criminal charges were filed against the psychiatrist after DNA testing, and his license was in the process of being suspended. A rigorous investigation eventually revealed that she had stalked the psychiatrist's home subsequent to the termination of treatment and had found several pairs of his semen-stained underwear in his trash containers—he was on a weight loss program, and his wife was throwing away his excessively large underwear in their trash. When confronted by the police, the ex-patient admitted to stealing the underwear and scraping semen from it. The charges against the psychiatrist were dropped
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See, it's these kinds of stories that make me worried. At least I'm glad to see that it's surprising to others, as well.
 
F0nzie said:
Never heard of a screamer.... Product link?
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If you google something like "screamer personal alarm," you'll get plenty of hits. I'm not being coy, I just don't want to provide a random link and imply endorsement.

There are the kind you activate with a push (a button) and the kind you activate with a pull (a ring). I'd recommend the latter, as you can hook the ring to a belt loop or some such and if things get hot you can pull it away from you and activate it (idea being that no one can pull it away from you and render it useless, as it will activate). Go for 120 decibels, if you can. Prep staff as to what it sounds like and establish a protocol.
 
SomeDoc said:
A rigorous investigation eventually revealed that she had stalked the psychiatrist's home subsequent to the termination of treatment and had found several pairs of his semen-stained underwear in his trash containers
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Note to self: when tossing old undies in the trash, wash them THOROUGHLY first...
 
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notdeadyet said:
There are the kind you activate with a push (a button) and the kind you activate with a pull (a ring). I'd recommend the latter, as you can hook the ring to a belt loop or some such and if things get hot you can pull it away from you and activate it (idea being that no one can pull it away from you and render it useless, as it will activate). Go for 120 decibels, if you can. Prep staff as to what it sounds like and establish a protocol.
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The one I had in a prison could be activated in 3 ways:
1) pushing a button
2) pulling a string that was attached to the alarm and could be hooked to your belt loop
3) have it turned sideways for like 5 seconds (so if you get knocked out, at least someone will come eventually)

But it was big and somewhat annoying. :/
 
I had a kid throw a ball at my head when I wasn't looking in the playroom once. Whacked him good with the nerf bats.
upload_2016-2-12_15-42-6.jpeg

If you can't beat up these little kids with a foam bat, then you are in real trouble. Those little bastards smell the fear like sharks smell blood in the water. I have had a few teachers as patients, they know the horror.
 
SomeDoc said:
Here is a memorable excerpt from an article on the issue:

Source: http://www.jaapl.org/content/41/2/200.full

Commentary: Stalking by Patients—Psychiatrists' Tales of Anger, Lust and Ignorance

Another female patient accused her psychiatrist of having sexual relations with her in his office during their psychotherapy sessions. The psychiatrist was mounting a vigorous defense until the patient brought to the local police dried semen from the psychiatrist that she stated had come from her underwear while having sex with him. Felony criminal charges were filed against the psychiatrist after DNA testing, and his license was in the process of being suspended. A rigorous investigation eventually revealed that she had stalked the psychiatrist's home subsequent to the termination of treatment and had found several pairs of his semen-stained underwear in his trash containers—he was on a weight loss program, and his wife was throwing away his excessively large underwear in their trash. When confronted by the police, the ex-patient admitted to stealing the underwear and scraping semen from it. The charges against the psychiatrist were dropped
Click to expand...
I'm not sure why I'm surprised by this, but it's still wtf-worthy. Suppose I should be more shocked that justice was served and the appropriate party exonerated.
 
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