Violent patients in Psychiatry

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Zuckman

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Hey Everyone,

I'm interested in psychiatry. However, I'm curious, do psychiatrists get threatened with violence from their patients. This is something that would frighten me and I'm not so sure if I could handle that well. Thanks for any responses.

Zuck

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Zuck, every specialty has its drawbacks. The major drawback of psychiatry is risk of violence from patients. There are strategies to minimize the risk, but you can never completely eliminate it. You must be aware of this, but do not let this concern prevent you from choosing an exciting and intellectually stimulating profession. When you get into medical school, see if psychiatry is a good fit for you - and if it is, whether you love it enough to live with the small but not insignificant risk of violence. I wisk you good luck.:thumbup:
 
The majority of psychiatric patients are not violent, but assaults can happen. A few years ago an expert in schizophrenia was murdered by one of his patients.

If you go to medical school, even if you don't want to specialize in psychiatry, you will have to do a rotation in Psychiatry. You definitely need to follow some common sense safety rules in a psychiatric setting. Stay aware of your surroundings and know where the panic buttons or whatever other safety mechanism the psych ward has are. Don't bring anything to the psych ward that could be used as a weapon against you (some of the psych facilities I rotated at had a rule against men wearing neckties for that reason). When you interview a patient, make sure you don't let the patient get between you and the door of the room in case you need to get away. If you need to talk to a patient who makes you feel uncomfortable then don't be shy about asking if someone else can come in the room with you to see them.
 
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Thanks everyone for the responses. I'm definitely interested in psych. I particularly like the subject matter and it seems that all the psychiatrists I've met have great lifestyles. It also seems like a slower pace specialty which is something that really interests me.

One thing I've noticed is that most psychiatrists I've met have really relaxed personalities...not sure if this is the norm really, but it's something I've noticed. I think that's pretty cool and it is very similar to myself.
 
One thing I've noticed is that most psychiatrists I've met have really relaxed personalities...not sure if this is the norm really, but it's something I've noticed. I think that's pretty cool and it is very similar to myself.
Agreed. I found some specialties really off-putting when everyone I met from them seemed incredibly stressed and angry. When you meet a specialty where everyone seems chilled and happy with their job, it's a great advertisement for it.

Psych really fit that bill. EM and PM&R too...
 
A buddy of mine & I work on what are perhaps the 2 most violent forensic units in the state.

Despite that I go to work each day, not worried I'll get attacked. Of course it can happen, you have to be aware of the danger, but its not something I actively worry about.

Violence can happen in the job. It can happen in any job. The thing you need to remember to assauge your fears are that you will be trained to deal with such things, and if the place you work at is of at least 1/2 decent quality, they'll have measures in place to prevent violence.

I wear what's called a spider on my ID necklace. Its a button that if pressed will automatically alert the campus police (no we do not have orderlies or security guards, we have real police) show up in seconds--and all cameras in the immediate area will flood the TV screens in the police office. Within 30 seconds, the place will also be teaming with staff--on the order of perhaps 20 or more people in addition to the police who will surround the violent patient. Violence prevention training is mandatory where I work. If need be, the police will show up in riot gear, all patients are rated on 2 levels of risk--special precautions risk, and general privelidges. Based on both, each patient is tiered as to their risk, and the corresponding level of freedom they are allowed to have in the hospital.

There's several other added security features. We can put bells on the doors so if patients leave their rooms-an bell sounds off. Its useful for patients who've been known to leave their rooms in the middle of the night & attack others. There's wrist to waist restraints which I've never seen until I've worked at my current place
http://www.pxdirect.com/images/Grip-Fixed-Rear.jpg
Which are for people who are chronically violent at all times, even when medicated.

I could go on & on.

Bottom line is violence can happen, but in any field something bad can happen--a random HIV infected needle prick, malpractice suits, etc. The violence factor is not something you should expect to happen to you so long as you practice the safety guidelines--and by then only expect something like that to happen once every several years.

If the place you work at does not have enough safety measures in place, make demands to have them implemented or get out of that place.

I've noticed is that most psychiatrists I've met have really relaxed personalities
Agree. This is perhaps biased, and not based on hard data but anectdotal experiences, but from my own experiences Ob-Gyn & surgeons tend to be the least tolerant & patient with others. Certain personality types seem driven to certain fields (this is a generalization).

However and self mockingly against fellow certain forensic psychiatrists, I've noticed plenty of narcissistic forensic psychaitrists--walk into court with the Armani suit, gelled up hair, and seem to have forgotten that its not their job to zealously defend anyone. They're just supposed to provide an honest evaluation, but at a few hundred to thousand dollars an hour, I think they've lost that perspective.
 
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I've been at this for awhile, and the most threatening situation was a father upset that I wouldn't release his suicidal daughter, but in stead was putting a hold on her. He wanted me to go out in the parking lot and fight me. Sure enough, she later related that he had been molesting her, so no surprise that he didn't want her in our reach.
 
I used to say it wasn't call unless you got threatened with a law suit at least once, but I haven't yet been fearful of my physical safety. Though I do know both nurses and a social worker who have been attacked and significantly injured by patients on inpatient units.
 
Just Finishing intern year, and on inpatient psych, I've was threatened by 2 people on different occassions. It definitely made me anxious, but it also taught me to not be complacent. It reminds you that you need to remain aware of your environment. 1 guy was an antisocial, malingering bully and the other was truly psychotic. It also made me angry and made me wonder if I should be in psych. I'm better now, but it's a terrible feeling.
 
Finished the year now. Only got threatened perhaps once. I kept prodding the patient because his story did not match and he seemed like a malingerer at first.

The risk of violence is what makes your job secure in psychiatry.. no one else wants to take that risk. So if you ask yourself.. why is psychiatry so chill with so little stress on the call compared to other fields... it's the risk you are taking that they are not taking.
 
To add another little bit of perspective, in all honesty I actually feel safer on my locked inpatient psych unit than I feel in most other parts of the hospital. Yes, patients have the potential to be violent, but it's a known risk, and every nurse, doctor, and tech I work with is well-trained to deal with dangerous situations as quickly and safely as possible. No one else in the hospital can do a safe take-down of a violent patient as quickly as my psych nurses. Plus I have the assurance of knowing that the patients have been searched and all dangerous items removed. And there is no dangerous medical equipment (sharps, iv poles, O2 tubing, etc) that anyone can use to harm themselves or others.

In contrast, I think the main ED is probably the most dangerous place to see patients. Not just psych pts. Folks walk right in off the street and you have very little prior knowledge of how they are going to behave. I used to work in a hospital that now has metal detectors because a few years back, a guy walked into the ED and shot a bunch of doctors and nurses. Other pts come in drunk or high or delirious and have taken a swing at the staff or worse. At another hospital nearby, a victim of gang violence was brought into the ED, and then the rival gang showed up in the ED with a gun to "finish the job"; staff and pts were caught in the crossfire. And finally, just this year I had a patient pull a knife on me in my own outpatient clinic.

Other than that, med-surg floors have the potential to be dangerous as well. Lots of stuff that can be used to harm someone. And the nursing staff is really not prepared to deal with it well either.

Wow, didn't mean for all that above to sound so scary. Bottom line: yes, some psych pts are violent, but some non-psych pts are violent. There is some potential for danger in any field of medicine. I wouldn't allow that to dissuade you from being a psychiatrist if that's what you're really interested in. If anything, as a psychiatrist I am better prepared to keep myself safe, because I am trained to EXPECT people to behave in unpredictable ways at times, so I'm less likely to be caught off guard. Oh yeah plus I have kick-ass nurses (did I mention that??) :)
 
Ancora psychiatric hospital in NJ--has a forensic unit filled with violent offenders, though according to them, that's their safest unit because it has the most security.

Again, violent patients aren't something you need to worry about to the point where it messes with the quality of your life so long as you've had the right training, and the facilities has the right measures in place.
 
Ancora psychiatric hospital in NJ--has a forensic unit filled with violent offenders, though according to them, that's their safest unit because it has the most security.

Again, violent patients aren't something you need to worry about to the point where it messes with the quality of your life so long as you've had the right training, and the facilities has the right measures in place.

Is there ever any worry of getting stalked, followed home, etc? Would many psychs get their address dropped out of phonebook?
 
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My behavioral science course director told us that as he was finishing up residency and preparing to move away, one of his patients with borderline pd tells him..."You know doc...now that you're moving away, I guess its ok to tell you this. Sometimes I would drive to your house and just sit there in my car. The thought of being close to you makes me feel secure." He said it kind freaked him out a little and it made him get an unlisted phone number at his next address. Now 20 years later he tells the story jokingly, and we all laugh. But...How common is it to have unlisted phone numbers and the like? Do you tell your significant other?
 
My behavioral science course director told us that as he was finishing up residency and preparing to move away, one of his patients with borderline pd tells him..."You know doc...now that you're moving away, I guess its ok to tell you this. Sometimes I would drive to your house and just sit there in my car. The thought of being close to you makes me feel secure." He said it kind freaked him out a little and it made him get an unlisted phone number at his next address. Now 20 years later he tells the story jokingly, and we all laugh. But...How common is it to have unlisted phone numbers and the like? Do you tell your significant other?

We're listed under Mrs. OPD's name, but there's enough of a paper trail out there if you own a home, pay taxes, etc., that the truly motivated psychopath will find you anyway... :eek:

Once a pt found me by calling every <real OPD last name> in the phone book and asking for "Dr. <Real OPD last name>". Freaked Mrs. OPD out, but fortunately he was just a demented manic pt that desperately wanted to report a side effect, accepted redirection to the nurse line and an admonition to "Never do that again". Most borderlines will accept a stern talking-to with some firm limit-setting.
 
We're listed under Mrs. OPD's name, but the truly motivated psychopath will find you anyway... :eek:

Yes, they can just follow you home one night...

I had a former in-patient stalk me. :scared: I worked as a student/researcher on the ward -- that was creepy although he wasn't set on killing me, he thought we had a "relationship". Sure I notified police and neighbors, but they weren't exactly helpful. The police said something like "uh, it's your job to deal with the crazy folks out there, ain't it?" I ended up paying for valet parking at the hospital during the day and getting security to fetch my car at night.
 
Is there ever any worry of getting stalked, followed home, etc? Would many psychs get their address dropped out of phonebook?

I've never had a problem, though I too just like OPD did would take precautions.

Have your phone number unlisted. Only provide people with your beeper number or work number (unless its people outside of work). I'd also have utilities put in your spouse's name if possible. Reason why is some search engines such as Zabasearch can still find people unlisted on in the phonebook based on that.

I've never had any problems with patients stalking me, though I know 1 person that has. I'd recommend not broadcasting your whereabouts just in case. Better safe than sorry.

Before residency started, I had some real concerns over psychotic patients vs privacy & safety. I even considered getting a gun & having a panic room. Nope--nothing ever went anywhere near to to the point where anything like that was needed. Worst thing that ever happened to me was a psychotic patient who threatened to kill me saw me at a DVD store. Though at that time, the person was cleared up, and was even thankful to me for helping him. A chill though did run down my spine for the first few seconds I saw him.
 
I've got a patient right now with a history of violence in inpatient settings. *shrug*

If you're smart it won't be an issue. Call your patients from the door. Don't see them in a room but out in the open in view of the nurse's station. Put a table between you.

Done.
 
The most commonly violent patients are those with delirium, which you see most often in medical/surgical settings. Of course, these are usually little old ladies or men, so the consequences of the violence are not as great as with a hulking irritable manic or an antisocial patient who has experience using violence to achieve his aims.
 
Just to add to the extremes to give you a frame of reference, where I worked in the last year--a forensic facility--filled with murders, people charged with manslaughter, felonius assault (AKA aggravated assault), aggravated arson, etc, not one of the doctors there to my knowledge has had someone stalk them, or have a "Cape Fear" type of sociopath out to get them.

Actually in those cases, its usually the doctor that is working to get them out. Often times, these people have been found not guilty by reason of insanity, and their doctor will approve of them being discharged after them showing stable behavior while medicated for an extended period of time, and a extremely realistic possibility that they will be successful in the community (e.g.--on a depot medication, will have a case manager etc). The institution will then send 2 more doctors to review the case just to make sure all the t's are crossed & the i's dotted. Then court will send their own doctor to double check the safety of the person, and will either approve or recommend to the judge to not allow the person out in the community. The judge will pretty much never allow the person out unless all the doctors involved agree the person is safe. None of those doctors to my knowledge has had someone out to get them either.

The 1 doctor I knew who had someone stalk her was fairly attractive, young, and had a nonpsychotic patient who was attracted to her. She confronted him, and told him he had to stop that behavior or she'd have to refer him to someone else. After that confrontation the problem stopped.
 
I've got a patient right now with a history of violence in inpatient settings. *shrug*

If you're smart it won't be an issue. Call your patients from the door. Don't see them in a room but out in the open in view of the nurse's station. Put a table between you.

Done.

I would be hesitant to shrug off safety concerns like that. I guess, my experience taught me different. When I started in my first ever psych rotation a couple of years back, my attending cheerfully reported that he had never, EVER been assaulted by a patient. Three months later, he was assaulted by a violent schizophrenic on a ward round - let's just say, he has never quite regained the vision in one eye, after six weeks off sick and an operation. Worse yet, just last year he was assaulted by another schizophrenic on a home visit - and this patient had never had ANY history of violence. Both the attending and his SW received multiple stab wounds, necessitating hospital treatment.

This is a guy with 20-something-years-long career in psychiatry. Just because you have not encountered any violence - or encountered minimal violence during one-two years of residency, don't shrug safety concerns off. They are real, and they do matter. Good luck.
 
Personally, I'd be going with the unlisted phone # no matter WHAT medical specialty I was going in to...

And the thing about zabasearch & utilities in the spouse's name - thanks for the "heads-up". I think all of our utilities have always been in my spouse's name for the simple reason that I was too busy (lazy?) to deal with setting them up, not for "strategic" reasons. So this is something that is good to keep in mind in the future!
 
I've got a patient right now with a history of violence in inpatient settings. *shrug*
I agree with BabyPsychDoc. The *shrug* is how people get hurt. Following precautions minimizes the problem, but doesn't eliminate it. Jail Psych and other violent inpatient settings can have actually less violence against practitioners because of heightened awareness and caution. But without the caution, it's a dangerous place.
 
To save MoM the effort, I think his *shrug* is being misinterpreted, since immediately after that he talks about the importance of doing all the correct things to keep himself safe. His point seems to be "be vigilant, be smart, follow basic rules, and then don't worry about it," which is quite a bit different than "eh, who cares."
 
His point seems to be "be vigilant, be smart, follow basic rules, and then don't worry about it," which is quite a bit different than "eh, who cares."
Ah, I see. I thought he was leaning the other way. The checkbox of safety measures followed by "Done" made me think it was more the "who cares" side of things.

Sounds like we're all of the same school of thought. Caution + following procedure must cut down on the lion's share of the attacks...
 
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The ones that DO hurt you is the sweet, little, old Alzheimer's patient.
 
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