psychiatry
Risk of Violence in the Workplace
Sun, June 1, 2008 at 12:02PM 
Every now and then The HEADoc finds himself in an undesirable inescapable situation. . .
Last week The HEADoc was trying to forge an alliance with the most delicate of cases; a teenager facing the difficult reality of the first psychotic break of Paranoid Schizophrenia. Failing to make a trusting bond with such a patient could adversely affect his future treatment outcome in many ways. This is the type of case that can truly test the psychiatrist's clinical abilities. As the patient made an effort to let down his psychological walls of defense for the first time, a ruckus was undeniably overheard coming from the front. The situation seemed to be escalating. It was a drug seeker unable to obtain his drug of choice from the local ER after claiming to have unlikely side effects from what he had been prescribed by The HEADoc the previous week. Profanities shouted at the nurse and receptionist along with racial slurs and demands for something to be done immediately reached the point they could no longer be ignored or overlooked. Thus, the limit was reached. In the words of Beyonce', "he must not know 'bout me." In the field of psychiatry, there are times when an emergency arises that cannot wait for reinforcements to arrive.
So The HEADoc finds himself in quite the predicament. He is in an important session with his most vulnerable case while being disturbed by his least desirable patient type. His staff is being verbally abused and threatened and his waiting room milieu has been disrupted in the most rude and disrespectful manner. In a previous entry where the HEADoc wrote of violent behavior becoming imminent in the office setting, a commenter criticized his angry confrontational manner of handling a 16 year old girl who was threatening violence. The commenter suggested offering her something to eat or drink to help calm the situation. In certain situations the textbook must go out the window. Risk management is crucial but mental health care is a risky business and shiggety inevitibly will happen. Statistically, over 80% of those who work in ER's or Mental Health clinics will personally encounter violence at some point during their career. One really doesn't know what their reaction will be until finding the situation arise for them. Restoring order with minimal harm becomes the ultimate objective.
So how did the HEADoc react? Hint: not with milk and cookies. This person had crossed the line clearly and the negotiation/compromise stage had expired into the enforcement stage. There does exist a legitimate career known as a bouncer who provides security to certain establishments. Most businesses just hope that situation where someone must be physically removed from the premises never arises. The police are not readily available and are a non factor in most of these situations. Without providing details, the violator was removed and threats to take out assault charges against The HEADoc were made. That is just a case that will have to be proven in court. The HEADoc describes the whole incident as regrettable and unfortunate for all involved but feels he did what he had to do and will do it again if the situation calls for such an interventive measure.
Feelings of guilt usually follow feelings of rage or anger, in normal people. How could The HEADoc return to his session with the young man he had to excuse himself from to try and restore the peace? Interestingly, the young man was not at all emotionally traumatized by the events. He in fact was able to see The HEADoc as a real human being with real emotions. The patient offered the doctor empathy and understanding and an avenue opened for him to discuss some of his own thought content in a therapeutic setting. Thus, a potential disaster turned into something positive.
Reader Comments (1)
DR. H. I have concerns as a patient as to why you allow your office staff to interrupt your therapy sessions. Patients need to feel they have some level of privacy when they are in session w/you. I would think it would have to be a dire emergency for staff to barge into a therapy session and interrupt a patient-doctor discussion. I'm angry at myself for not just getting up and walking out--I came to your office twice and waited a total of 2 hours and 30 minutes--I think I deserved at least an uninterrupted few minutes of your time.