Patient Violence Against Physicians: What You Can Do

Leigh Page

Disclosures

April 30, 2019

In This Article

Protecting Yourself in Advance

If alerted to the possibility of violence, healthcare workers can control the encounter in several ways, Battaglia says. If a patient arrives in handcuffs, for example, they could conduct the whole initial interview with the patient still in handcuffs. If the patient continues to seem violent, Battaglia might say, "We're going to stop talking because you're frightening me."

Most violent incidents occur without much warning, so it's a good idea to take routine precautions. Experts advise never to be alone with a patient, and if that's not possible, to keep the door ajar. Don't put the patient between you and the door, so that you can escape, and make sure your potential escape route is not blocked by furniture.

Except when examining the patient, stand outside of arm's reach. The space will help you see a potential attack coming and defend yourself. The person could use fists, fingernails, feet, teeth, head, body fluids, or objects in the room.

Battaglia also suggests sitting at a 90-degree angle with the patient and not straight on. This limits sustained eye contact that could set off some patients.

When leaving the building after hours, look around you instead of down at your iPhone, and if you're concerned, ask security or another healthcare worker to escort you to your car. In a 2005 survey of Michigan emergency physicians, 31% obtained a security escort.[14]

When You Need to Handle Violent Patients

You can often sense impending violence a few minutes in advance. The run-up to violence often involves shouting, expletives, and certain body language such as eyes darting back and forth, a focused stare, pacing, rapid breathing, and clenching jaws and fists.

The violent patient may grab your hair or your arm. Ways to break free from these holds are taught in defense courses for healthcare workers. Once free, you should try to flee. When you flee, Battaglia suggests telling agitated patients what you are doing, so that they know it's not an attack: "Bob, I am standing up now because I need to leave the room."

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