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Student safety and patient violence: the basic facts

K.J. Black, M.D., 5/8/98, reviewed 4/6/99

Introduction: When our main view of patients is that we are there to help them, it seems odd to discuss the possibility that they may hurt us. Fortunately, this is rare. Unfortunately, it does happen. Below I have tried to give a few facts and hints to help keep you safe during your clinical years as a medical student.

Facts about patient violence:

  1. Violence does occur in the hospital. Incidents that my colleagues or I have encountered here in the 1990s include finding out that agitated patients are carrying a gun or knife, being verbally threatened by a patient, or having a patient try to hit us. Rarely physicians are seriously injured by patients.
  2. Nurses and other personnel are more at risk of on-the-job violence than we are.
  3. Violent patients can be seen in any part of the hospital.
  4. However, in general terms, violence is more likely to occur in some areas of the hospital than others, especially in the emergency room, intensive care and trauma units, locked wards, and pediatric wards.
  5. Violent patients can be of any age and have any diagnosis. For instance, people with known psychiatric illness are no more likely as a group to be violent than anyone else.
  6. However, certain patient characteristics tend to predict higher risk, and you should take more care in these situations. For instance, a few years ago we recommended to Barnes Hospital that as a general rule, patients with the following characteristics should put on hospital gowns and be separated from their personal effects before evaluation by the physician:
    1. patients who endorse violent thoughts;
    2. agitated, intoxicated, violent, or grossly confused patients;
    3. patients brought in for any reason by police;
    4. patients who refuse to answer questions about violence or weapons; or
    5. patients who have a history of violence.
  7. Violence is more likely to occur during confrontations, e.g. denial of desired drugs, involuntary commitment.
  8. Doctors who are irritable or confrontational by nature may be more likely than others to be attacked by a patient.
  9. E.R. surveys show that most patients actually feel safer with searches or metal detectors.
  10. Since patient violence is uncommon, physicians and staff tend to become careless over time unless reminded and trained frequently.

Hints and resources:

  1. General and preventive suggestions:
    1. Think about safety issues occasionally. Use common sense.
    2. Familiarize yourself with safety features, e.g. panic buttons, when you start work at a new site.
    3. WUMS protective services and others have offered helpful training in personal safety.
  2. When seeing a patient described in #6 above:
    1. Make sure there are no weapons present during your evaluation (see #6 above).
    2. Sit down. Speak calmly. Avoid confrontation.
    3. Have hospital security with you during your evaluation or at key moments (e.g. for injections, or when telling the patient something they don't want to hear).
    4. Sit between the patient and the door. Don't lock the door.
    5. Feel free to discuss safety concerns with the attending physician, or the coursemaster, at any time.
  3. Possible sources for further information:
    1. Black KJ, Compton WM III, Wetzel M, Minchin S, Farber NB, Rastogi-Cruz D. Assaults by patients on psychiatric residents at three training sites. Hosp.Comm.Psychiatry 1994;45:706-710.
    2. American Psychiatric Association. Clinician Safety: Task Force Report 33. Washington, DC: American Psychiatric Association, 1993