Patient Violence Against Physicians: What You Can Do

Leigh Page

Disclosures

April 30, 2019

In This Article

Can Martial Arts Training or Guns Protect You?

To defend themselves against possible attack, some healthcare workers take classes in martial arts, such as tae kwon do, hapkido, or krav maga. Butler thinks these classes can be helpful. "They teach people to think defensively," he says. "You become much more aware of your surroundings."

Butler says his company does not teach martial arts in its self-defense classes, however. "We keep our defensive techniques much simpler, like how to break a wrist grab or a hair pull," he says. "These are tactics you can remember, that will be useful in your everyday work environment."

Butler does not approve of pepper spray or mace. "Pepper spray doesn't stay where it's deployed," he says. "It gets into ventilation systems and can seriously affect patients." Also, Battaglia is concerned that any kind of weapon, even pepper spray, can affect one's role as caregiver. "It puts you in a different frame of mind that doesn't go well with the mission of taking care of patients," he says.

Weapons are sometimes used by physicians for self-defense. In a survey of Michigan emergency physicians, 18% said they carried a gun, 20% a knife, and 7% mace.[14] A male nurse practitioner, commenting on a previous Medscape article on healthcare violence, said he didn't use his gun when a patient confronted him in the parking lot at closing time, "but it still felt good having my personal firearm on my person."[15]

Butler, a former police officer, doesn't condone use of guns. He says there aren't any hospitals that he knows of that allow workers to carry guns. "Guns take a lot of training," he says. "It's not as simple knowing how to shoot them."

One danger of shooting guns inside buildings is that the bullets can penetrate drywall and hit unseen people in adjoining rooms. Also, guns can be wrested away from their owners, even in the case of trained security guards. In 23% of shootings in the ED, the perpetrator took the security officer's gun, according to a 2012 study.[16]

Dealing With the Aftermath of an Attack

When aggressive patients are starting to come down from their violent high, it is time to start reasserting control, Butler says. "At this point many will start to be apologetic about their outburst," he says. "This is when you begin to set boundaries for acceptable behavior as well as consequences for unacceptable behavior."

It is up to the person who was assaulted to file a charge against the assailant with the police, but Butler says charges are rarely filed. "Calling in the police is for serious events," he says. "And even in some serious events, the police or district attorney's office won't accept the complaint, because the assailant has to have knowingly and willingly committed the crime. Some people such as a dementia patient who had a violent outburst, don't meet that standard."

It's important to provide counseling to the victim before the incident can produce long-lasting trauma. Cooke says this catharsis counseling can be done privately after the incident.

Separately, victims should undergo debriefings about the incident to provide insights into why it took place and what could be done to prevent it, Cooke says. She says debriefings should occur immediately after the incident. "If you wait a week, the victim might begin to think it was no big deal," she says. "People learn best just after they have experienced a crisis."

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