PRINTDoctors face daunting days
Physicians put their lives on the line when dealing with potentially dangerous patients
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December 18, 2008 | 12:00 a.m. CST
Dr. Nora Frohberg, a psychiatrist at University Hospital, has seen it all. Although many doctors say they have been verbally abused or even threatened by a patient, few can offer stories that compare to hers. During Frohberg’s time in residency, she has been physically threatened and had to move to avoid a schizophrenic patient who was stalking her. She has even had a knife pulled on her while a patient was having a post-traumatic stress disorder flashback of being attacked.
Although these horror stories seem to be the stuff of TV fiction, they are actually real events that doctors and nurses face on a regular basis. To put the frequency of violent attacks in the medical field into perspective, a U.S. Department of Justice survey states that across all occupations, 12.6 employees out of every 1,000 will
be the victims of nonfatal, work-related violent crime. The rate for doctors is 16.2 per 1,000 while psychiatrists and mental health professionals have a substantial rate of 68.2 per 1,000.
Frohberg recalls one instance when a colleague could have been killed during an altercation with a patient. What made the situation even more alarming is that both the patient and the doctor had earned black belts in martial arts, making violence a potential for the situation. “The patient became angry at my partner on the unit because he wanted to leave the hospital against medical advice,” Frohberg says. “He started circling my partner with his fists clenched and then came closer to attack him physically.” The patient then went in for the attack by attempting to kick the doctor in his abdomen. Luckily, the doctor’s black belt training allowed him to simultaneously move away from the blow while deflecting some of the kick’s force with his arm. The patient did make contact, but the contact was only great enough to cause slight bruising instead of the internal damage Frohberg suspects could have occurred.
According to Frohberg, her partner felt that the patient’s military training might have added another element of danger. “Plus, he was very strong physically,” she says. “My partner definitely feels that if had he not defended himself that the patient could have killed him.”
Similarly, Dr. Armando Favazza, a Columbia psychiatrist associated with University Hospital, has had experiences with violent patients. “I have seen a lot of really angry and paranoid patients,” Favazza says. “I usually can talk them down or suggest that they might want to leave and come back when they feel they can
trust me. Still, one of my residents was slapped pretty hard by a VA patient with PTSD when the patient found out that the resident was a Muslim.”
The figures for violence in psychiatric wards are already staggering, but it is likely that the numbers of violent attacks are still underreported. In a 1998 study of three psychiatric units, 1,289 violent attacks were recorded over a period of seven months. Fifty-eight percent of those attacks were characterized as serious by the assaulted staff.
Although the statistics for attacks are scary, not all patient attacks are life-threatening. Dr. Delee Har, now a pediatrics resident at Cardinal Glennon Children’s Medical Center in St. Louis, was working in a Psychiatric Intensive Care Unit when a patient’s cravings for fast food became a fast problem. Har was taking care of a female patient with a history of psychiatric disorder, who was in the unit for a diabetic illness. After enduring the patient’s screams for a cheeseburger and catching the patient’s girlfriend in her bed while attempting to feed her the cheeseburger she craved, the doctors had to tell them to stop.
“When I told her she couldn’t eat the cheeseburger, she got up right in my face, started screaming and swearing,” Har says. “She took the cheeseburger and shoved it in her mouth, and she started throwing food and other hospital items across the room.” In spite of the patient’s violent tantrum, Har stayed in the room and was able to talk the patient down without harm being caused to anyone.
Despite these disheartening stories, the problem seems to be improving. According to Department of Labor Statistics, the number of nonfatal, work-related injuries in psychiatric and substance abuse hospitals has decreased by several hundred injuries from 2006 to 2007. Still, the number of injuries stack high and more can be done to improve upon the safety of the hospitals. Until then, one thing will remain the same: a passion for helping their patients overcome whatever problems they might face.
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