Violence in the workplace: It could happen to you

Despite living in the same town, practicing in the same specialty, and worshipping in the same faith, I didn’t know of Dr. Ron Gilbert until the day he was killed. A urologist in my community, he was shot to death in an exam room on Jan. 28, 2013, by a patient he never even provided care for. The alleged gunman was apparently frustrated by the incontinence he suffered following a urologic procedure elsewhere.

Then, less than a year later, Dr. Charles G. Gholdoian, a urologist in Reno, NV, was shot and killed at his practice. Dr. Gholdoianʼs partner, Dr. Christine Lajeunesse, was critically injured. It was reported that the gunman had been suffering with a possible complication from a prior vasectomy.

According to the U.S. Department of Labor's Bureau of Labor Statistics (BLS), there were 69 homicides in the health services from 1996 to 2000. In 2011, the BLS reported a total of 468 workplace homicides. Seven of these occurred among “health diagnosing and treating practitioners,” four of whom were physicians. According to the BLS, while workplace homicides “may attract more attention,” most workplace violence results from non-fatal assaults.

The Department of Justice's National Crime Victimization Survey for 1993 to 2009 lists average annual rates of non-fatal violent crime by occupation. From 2005 to 2009, the average annual rate for non-fatal violent crime for all occupations was 5.1 per 1,000 workers. The rate for physicians was 10.1 per 1,000, and for nurses, 8.1 per 1,000.

I’ve cared for thousands of patients in the last 20 years, and while I have never been physically assaulted by a patient, I have occasionally felt threatened to the point where I’ve discontinued a visit and had a patient dismissed from my practice. These events, though uncommon, can be unnerving, given the unpredictability of human behavior.
 I know that I spent some time looking over my shoulder after a challenging patient encounter. I’ve had patients become belligerent after being denied refills on controlled substances. Another became threatening after his demands for a penile augmentation procedure were denied. And a recent threatening encounter involved a patient who told me that he would be “vengeful” if I suggested he be tested for HIV.

As health care providers, our prime directive is to help our patients. Unfortunately, this altruism does not exempt us from the possibility of a violent act by a patient against us or our staff.
We have few defenses at our disposal should a patient decide to become violent during a clinic visit. It would behoove all of us to have a system in place to alert staff to a potentially escalating situation with a patient, and perhaps have the exam room laid out in a fashion that keeps the practitioner within easy reach of the door. Recruiting local law enforcement officials or representatives of federal or state occupational and health safety administrations may be of benefit in helping to develop a proper algorithm and exit strategy when faced with a potentially violent patient encounter.

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