When a hospital patient becomes violent

In this April 25, 2014 photo, a sign points the way to Flint River Hospital which closed its emergency room last year, in Montezuma, Ga. Residents must now drive 20 or 30 miles on slow country roads to the nearest hospital. Alarmed by hospital closures, health officials in Georgia are changing rules to let stressed rural hospitals become expanded emergency rooms that can also handle routine childbirths or outpatient surgery. (AP Photo/David Goldman) (The Associated Press)

I can remember the first time I witnessed a patient become violent. A middle age man had been brought to a suburban ER where I used to work.  He was on a stretcher in a hallway.  Suddenly, he was off the stretcher, screaming, as he ran toward the nursing station. Like a blur, from the opposite side of the ER, two security guards came running towards the man. They tackled him, pinned him to the floor, and put him back on the stretcher, and put his arms and legs in leather restraints.

I’m glad that CMAJ published an editorial on the topic of violence because it doesn’t get enough attention.  Still, I found it curious that it singles out physicians as victims of patient violence without talking about other professions.  

A few years ago, we did a show on White Coat, Black Art that focused on violence against paramedics.  Unlike other health professions, paramedics are at increased risk because they get little advance warning of impending violence.

The push to deal with the problem now comes from reports of high profile cases in which health professionals have been severely beaten. That’s what happened when a patient at a psychiatric unit assaulted a doctor in Penticton, B.C., causing severe facial injures, a broken jaw and other fractures.  There are many more instances in which nurses have been assaulted and ended up with severe injuries.  A survey in Canada found that three quarters did not seek help and nearly two thirds did not report the incident.   

The editorial calls for research into violent patients.  I endorse that idea only if it leads to practical ways to prevent it or mitigate the risk.  Violence is yet another reason why we need urgently national and provincial drug strategies to deal with the opioid epidemic.  

A four-day training program called Omega has been shown to increase the confidence of health professionals that they can handle the situation.  Other measures in hospitals include a red flagging system to alert personnel to repeat offenders.  Security cameras can act as a deterrent. Panic buttons and communication with colleagues that a potentially violent patient has arrived also help.  

Dr. Brian Goldman is host of White Coat Black Art, and the house doctor for CBC Radio One.  He works in the ER of a Toronto hospital.