Medical practitioners in the United States have been warned by the American Psychiatric Association of the increasing danger posed by some of their patients. It is reported in the Journal of the American Medical Association for August 2 that at least one physician in that country is killed every year by a patient being interviewed. In order of susceptibility to murder, psychiatrists and other mental health professionals come fourth, after taxicab drivers, store clerks and police, while 80 per cent of nurses have reported being physically assaulted at least once during their career. One major factor in this phenomenon is that citizens in the US possess more than 200 million guns between them.
The American Psychiatric Association has drawn up some suggestions that might help to counteract this threat to physicians, and asserts that many such murders might have been avoided had a few simple precautions been taken. There should be provision for training in medical schools in the assessment and management of violent patients. For example, there are warning signs to look out for. Potentially violent patients often pace the floor, clench and unclench their fists, glare, or otherwise show signs of agitation. Clinicians who fail to heed such warning signs are more liable to suffer attacks. Suspicion of abuse of alcohol or other drugs gives warning, as do loud outbursts of speech, and a wise physician will attempt to retreat from the situation of being left alone with the patient. The tension may be defused if the physician takes up some non-threatening posture in the face of rising tension.
An emergent violent situation and assault may occur in a confined space, such as an inpatient unit, emergency unit or private consulting office. Interview rooms should be planned to have an alternative means of access and escape. They should have heavy and soft furniture that cannot be used as a weapon. There should be some means of warning and summoning other professionals in the building. Sole practitioners working in isolated offices should avoid interviewing suspectedly violent patient in them, and should ensure that potential offensive objects such as sharp letter openers or statuettes are not in evidence on their desks.
Means of sedation such as benzodiazepines or powerful neuroleptics should be at hand, although these drugs need intramuscular or intravenous injection to be rapidly effective, and require the presence of a second person in the consulting room. If a patient is perceived to be on the verge of losing self-control, verbal and other personal intervention, perhaps reinforced by an oral medication, may prove useful. In any event, preparations for an emergency should be thought out in advance. Self-defence is important, but this does not imply that the physician should carry a gun during the course of his or her work.