Violent attacks on health practitioners have become increasingly common whether in a hospital or the practitioners’ consulting rooms. The very people that are trying their best to help the public are under attack.
A patient’s violent behaviour may be due to their underlying personality, a medical condition, intoxication by drugs and/or alcohol, or a combination of these.
Often there is little opportunity to predict a violent outburst from a patient and, while it is tempting to retaliate to a violent outburst with violence, any physical response that is not reasonable and in self defence is ill advised. It may be considered unprofessional conduct (or professional misconduct) and you could face disciplinary action from your employer and criminal charges as well. We have assisted doctors in the past with such enquiries following their physical response to a patient’s violent conduct.
So how do you deal with a violent patient safely?
It is very important to obtain as much information about a presenting patient to anticipate a potentially violent interaction. The old adage ‘Forewarned is forearmed’ is particularly applicable in this situation:
- The patient may have a history of aggressive behaviour that has been noted on their file
- If the patient presents to the emergency department, the ambulance officers may be able to share some important information about the patient’s behaviour
- As part of the history taking it would be important to obtain a history about the patient’s recent alcohol and/or drug use which may also predispose them to violent behaviour.
As far as reasonably possible you should do your best to make sure the patient does not feel threatened in any way.
It is important not to administer any sedative medication unless the patient is actually exhibiting threatening behaviour. If they have decision making capacity it may be a criminal assault if the patient refuses sedative medication and you continue to administer it without justification.
If the patient is exhibiting or threatening violence, a physical examination may be impossible or, at the very least, limited. In this situation you should do the best you can and not put yourself and others at risk by attempting to physically examine a violent patient without adequate assistance.
We assisted a general practitioner in a rural community where a severely intoxicated patient had been involved in a physical altercation with another person and was knocked unconscious after being hit in the head with a baseball bat.
The patient presented to the practitioner as clearly intoxicated and had been transported to hospital in a semi-lucid state. The practitioner had attempted to examine the patient but the patient was physically violent and affected by alcohol such that examination was impossible. The practitioner relied on information conveyed to him by other nursing staff who had viewed the patient talking openly to his family at his bedside. Any attempt by any health practitioner to physically examine the patient was met with a violent outburst.
The practitioner had discharged the patient from the local health facility without ever physically laying hands on the patient and in particular examining a head wound. The patient was allowed to go home but within a few hours collapsed and died from a subarachnoid haemorrhage.
The death was subject to a Coronial investigation and Inquest and the practitioner was investigated by the Medical Board for failing to adequately assess the patient. Unfortunately the practitioner’s notes were absent, particularly with respect to attempts to examine the patient being met with violent outbursts.
If you find yourself in a similar situation it is very important that you document that a limited examination has taken place due to the patient’s violent behaviour.
In these situations it is also important for the practitioner to assess their environment to ensure that they have an exit path should the patient’s violence escalate. You don’t want the patient between you and your only exit route.
In a private practice setting an emergency response strategy should be implemented and all staff trained in responding to a violent patient presenting in the waiting room or if a doctor or nurse is ‘trapped’ in a consult room with a violent patient.
If you have been subjected to violent patient behaviour
Despite the precautions, physical assaults by patients still occur which can be very distressing. Unfortunately at times the judicial system does not adequately punish the offender and it is possible that the practitioner will come into contact with the patient again.
In these circumstances, it is wise to adopt strategies to ensure that the patient does not interact with you again. In extreme cases, a Restraining Order (also called an Apprehended Violence Order or Personal Protection Order) can be obtained, which prohibits the patient from contacting or approaching you. This is achieved by application to the Court and MIGA can assist you if this course of action is necessary.
Violence in the health care setting is unfortunately an increasingly common occurrence. Adopting appropriate strategies can help minimise the chances of it happening to you.