Violent Patients

[Nycpac33]

How do u react/what do u do if a patient tries to assault u or threatens violence?

[Hemmingway]

If they threaten I tell them to leave. If they don't immediately I have the front desk call the police. If they actually try to assault me I disable and control them as quickly as possible by the most expedient means. Then they go away in hand irons. Being a pretty big guy that hasn't happened often but angry or mentally ill folks don't often think or act rationally. Defense of self, staff, and other patients first. Other concerns second.

Edited June 25, 2018 by sas5814

[Reality Check 2]

The VA does whole training sessions on this.

Steady voice, set boundaries - "please do not use profanity. We can talk if you can sit down and we can focus on the issues"

Sounds hokey but works. Threats don't respond well to threats. Posturing yourself doesn't help.

I have 2 keys on my keyboard that - when punched together - bring the police to my room, exact location.

I also keep a clear path to the door in my room setup so as to never be trapped. I use my spidey-sense to judge the situation at the get go and have someone outside the door listening for escalation or interrupting at a set time to see if all is ok.

My old office had a hot key under the front desk that called the sheriff's dept.

Never had to use force but I have stood up and used firm gaze, steady voice and ended the encounter.

Threats are serious - reporting them to the police is a must. Keeping records in the chart. ANY threat against you or your family has to be taken seriously. We lost a specialist in town to moving away quickly - a patient's family threatened his children and named their school. He couldn't take it anymore and took a job over 2500 miles away.

In a private practice - threats of harm or any type of violent outburst usually meets with the certified letter dismissing from care. Had a guy chuck a waiting room chair in the past - other patients were in the room. The police came - he didn't get arrested but was dismissed verbally and by certified letter and the police told him that because the doc wouldn't press charges (another story) that he wasn't in the clear - beat it, don't come back and they would be checking on him.

Set the boundaries - don't challenge - they ARE angry - worry about the rationale later - but don't be a doormat.

[CAAdmission]

Learn some aikido. You can cause someone tremendous discomfort while looking very gentle. 

A guy got handsy with me once. Wrist lock + elbow lock until security arrived. They were puzzled why I called for help because the guy wasn't moving a hair and it looked like I was just standing there. 

[trazodone]

Firm voice is helpful. I usually have my MA outside of the room as a listen in case things go south.

We have a text messaging system on our computers which is pretty fast and has been used...in the reverse, I will sit in the room while she rooms the patient if they are belligerent, rude, etc.

As for follow up, it won't be with me. I recommend dismissal and if not, they will need to see another provider. You only get one strike when it comes to safety for me. 

[EMEDPA]

2 minutes ago, CJAdmission said:

Learn some aikido. You can cause someone tremendous discomfort while looking very gentle. 

A guy got handsy with me once. Wrist lock + elbow lock until security arrived. They were puzzled why I called for help because the guy wasn't moving a hair and it looked like I was just standing there. 

agree. I took a few years of Aikido in college (2) and trained fairly intensively in my 30s(there was a dojo around the corner from my apt). One of the regular class members was a retired cop in his late 70s who could tie me in knots. do a search for "police aikido" for some of the most practical holds. I practiced a style called seidokan aikido. http://www.seidokan.org/index.htm

wish there was a dojo near me today. will probably start again when I retire.

[GetMeOuttaThisMess]

1 hour ago, Reality Check 2 said:

The VA does whole training sessions on this.

Steady voice, set boundaries - "please do not use profanity. We can talk if you can sit down and we can focus on the issues"

Sounds hokey but works. Threats don't respond well to threats. Posturing yourself doesn't help.

I have 2 keys on my keyboard that - when punched together - bring the police to my room, exact location.

I also keep a clear path to the door in my room setup so as to never be trapped. I use my spidey-sense to judge the situation at the get go and have someone outside the door listening for escalation or interrupting at a set time to see if all is ok.

My old office had a hot key under the front desk that called the sheriff's dept.

Never had to use force but I have stood up and used firm gaze, steady voice and ended the encounter.

Threats are serious - reporting them to the police is a must. Keeping records in the chart. ANY threat against you or your family has to be taken seriously. We lost a specialist in town to moving away quickly - a patient's family threatened his children and named their school. He couldn't take it anymore and took a job over 2500 miles away.

In a private practice - threats of harm or any type of violent outburst usually meets with the certified letter dismissing from care. Had a guy chuck a waiting room chair in the past - other patients were in the room. The police came - he didn't get arrested but was dismissed verbally and by certified letter and the police told him that because the doc wouldn't press charges (another story) that he wasn't in the clear - beat it, don't come back and they would be checking on him.

Set the boundaries - don't challenge - they ARE angry - worry about the rationale later - but don't be a doormat.

You have a better setup than I did.  No training.  Room setup not conducive to escape.  Our clientele just brought their own firearms.  This is Dallas VA.

[Nycpac33]

How would u guys react to a patient who threatens suicide at the office? Long story short I had a patient who threatened to kill himself if i dont write him pain medication (our facility does not write controlleds and i explained that to him) and he said well then i will walk out of here and kill myself and it will be your fault. I said please hold o while i speak to my superior about your request and see what we can do for hou and called the cops and ems. Thanfully pt just sat in the room with the door closed. How would u guys approach this? It was my first experience dealing with something like that

[jmj11]

My stethoscope is also a taser. 

[TheGunsnMoses]

32 minutes ago, jmj11 said:

My stethoscope is also a taser. 

How long until they become a lit man?

[jmj11]

And my bowtie is really a camera.

Seriously, I was only assaulted once, by a homeless women when I told her the seizure she wasn't having was a real seizure. Pissed her off. She was a professional patient and I was insulting her profession, apparently. She kicked he squarely in the balls and hit me over the head with the arm of her wheeled chair. Pissed me off. The medics were called and she was strapped to a gurney where she was taken to you kind folks in the ER, with the rubber room and syringes of neuroleptics and benzos.

Edited June 26, 2018 by jmj11

[rev ronin]

1 hour ago, Nycpac33 said:

How would u guys react to a patient who threatens suicide at the office?

Call 9-1-1, discharge them regardless of outcome.  Heck, I'll do it in front of them, all the while watching carefully.

[thinkertdm]

In some states, assaulting a provider is a felony:

https://www.nysut.org/news/2015/december/new-law-expands-protections-to-more-health-care-workers

Also, the VA I'm at does not have the keyboard alert or pull under the desk alarm.  I guess I just scream.  But we do have the disruptive behavior board, which can flag charts in certain scenarios, and the huddle, where we can come up with a plan for Mr. Disruptive.  We also have Skype, so I can contact someone on my team to knock on the door.

[ventana]

I work in corrections and deal with this a fair amount but the deck is stacked agains them...

 

but usually speaking softly, (forces them to listen)

Validate that they are in a tough way

ask for their help to work together to figure out a solution

 

all else fails walk out of room (keep a direct line to the door - unobstructed by patient)

 

 

 

a little thing to consider - I have had to change the way I do my exams

 

I stand off to the side for most exam so never directly in front

I now make sure to NOT close my eyes when doing heart exam - I used to do this to visualize the blood flow

for laying down exam - I at times will "block" them from hitting me by very causally using my other forarm across their chest or arms (they likely never realize this) so that they do not get an unobstructed clear shot to my head with a punch

 

At times (with the truly evil) I have someone in the room with me

 

 

in private practice - you threaten me or my staff - I will politely and quietly get you out - then you are fired immediately 

[EMEDPA]

10 hours ago, jmj11 said:

And my bowtie is really a camera.

 

nice Simon & Garfunkel reference reference

Let us be lovers, we'll marry our fortunes together
I've got some real estate here in my bag
So we bought a pack of cigarettes and Mrs. Wagner's pies
And we walked off to look for America
Cathy, I said as we boarded a Greyhound in Pittsburgh
Michigan seems like a dream to me now
It took me four days to hitchhike from Saginaw
I've gone to look for America

Laughing on the bus, playing games with the faces
She said the man in the gabardine suit was a spy
I said, be careful, his bowtie is really a camera
Toss me a cigarette, I think there's one in my raincoat
We smoked the last one an hour ago
So I looked at the scenery
She read her magazine
And the moon rose over an open field

Cathy, I'm lost, I said though I knew she was sleeping
And I'm empty and aching and I don't know why
Counting the cars on the New Jersey Turnpike
They've all come to look for America
All come to look for America
All come to look for America

[thinkertdm]

8 hours ago, ventana said:

I work in corrections and deal with this a fair amount but the deck is stacked agains them...

 

but usually speaking softly, (forces them to listen)

Validate that they are in a tough way

ask for their help to work together to figure out a solution

 

all else fails walk out of room (keep a direct line to the door - unobstructed by patient)

 

 

 

a little thing to consider - I have had to change the way I do my exams

 

I stand off to the side for most exam so never directly in front

I now make sure to NOT close my eyes when doing heart exam - I used to do this to visualize the blood flow

for laying down exam - I at times will "block" them from hitting me by very causally using my other forarm across their chest or arms (they likely never realize this) so that they do not get an unobstructed clear shot to my head with a punch

 

At times (with the truly evil) I have someone in the room with me

 

 

And no open toed shoes, you left that out.

[Cideous]

We have panic buttons all over our office under the desks.  The worst patients are DOT physicals.  The only patients that have threatened me or my staff.  It doesn't hurt that many in my office carry a concealed firearm.  This is Texas after all.

[Guest ERCat]

It is depressing that so many people here are familiar with these situations. In the ER, I have never had a patient ever lay a hand on me but I consider yelling / screaming, using expletives, and getting up from the stretcher to get closer to me threatening behaviors. In these cases I will call the patient out (“Our nurses work hard and it is very unacceptable to me for you to call Sally a b****” or “I don’t appreciate you raising your voice or cussing at me.” Then I sit down and ask them to work with me to come to an understanding. If this doesn’t work I stand by the door, my body almost out in the hallway, so everyone can see and hear and be on alert to notify security.

[CAdamsPAC]

2 hours ago, bobinski said:

I keep a tactical pen hooked to my scrub pants. Not much but gives me a little reassurance if I ever have a threatening situation.. not that I've had to jab someone yet.  You can find some pretty cool ones on amazon. It's better than nothing and I can't exactly carry my SW subcompact at work. 

I own a couple of these pens. One is always on my desk another in my chest pocket. No one knows what they are except " a cool looking pen".

[CAdamsPAC]

I let them know that threats and profanity will not get them anywhere, except discharged from the clinic.