Explosive Patients: Facing Violence in the Exam Room

The murder of Dr. Michael Davidson, a cardiac surgeon at Brigham and Women’s Hospital, has saddened and horrified us all. He was shot to death while on duty at his workplace on January 20, 2015 by the disgruntled son of a deceased patient. As time passes, we hear all the stories of what a remarkable doctor he was and feel the loss in our medical community.
However, his death has further struck a chord with many of us. Doctors are all thinking, “that could have been me” as we recall aggressive and hostile patients we have encountered in the past. I doubt that any doctor has never had a patient that they were genuinely afraid of or threatened by. The more years we practice, the more such stories we can tell.
The worst I personally encountered was a patient I refused to give a prescription of a controlled substance because I felt that she was abusing it. She went home, called my staff and told them to get out-of-the-way because she was coming back to kill me. She ended up with 6 months of probation and a permanent restraining order against me. I spent many months looking over my shoulder.
It is especially difficult for our emergency room colleagues who have no choice which patients they must treat. They have to see every patient that walks through the doors. Many of them have been victims of violence and aggression. Yet, if these same patients walk through those doors again, there is no choice but to treat them again.
While we understand that patients are often not at their best when they see us, there are limits to what behavior is tolerable. Some patients threaten to sue us if they don’t get what they want. Others become verbally abusive and still others threaten physical violence. Doctors should never be demanded to prescribe medicine they judge inappropriate out of fear of their lives or medical licenses.
The example of Dr. Davidson should serve as an example to us all the extremes disgruntled patients can go to when they are not happy. Too many doctors feel they have no control over these situations and their employers often dictate that they must continue to treat these patients. Many are lax in protecting doctors and healthcare workers because a murder such as this is just so unbelievable. We need to all be on alert. As more patients become disgruntled in our current healthcare system, hostilities rise. A doctor, or anyone else for that matter, should not be forced to treat or deal with someone they are fearful of.
Doctors also need more training on managing explosive situations in the exam room. Usually, we are totally focused on the patient’s medical condition. We need to have protocols in place when we feel a patient is getting aggressive. It is never wrong to call the police if we feel threatened. For the most part, the police are very sympathetic to our concerns.
No doctor should ever be the victim of violence by patients or their families. Patients may not like our decisions and this is their right. But, it is never justified to take out their frustrations in violent and hostile ways. If someone is unhappy with a doctor, go find a new one. If someone feels they were harmed by the actions of a doctor, there is a tort system in place to discuss their concerns. We need to protect those on the frontlines saving lives. Society needs their skills and they are irreplaceable. The world lost a great life saver and man in Dr. Davidson. We should all strive to make sure that this never happens again.

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