Returning to work after a patient assault

PFA can be compared to medical first aid in the field prior to reaching the hospital. In the case of Dr. M, other residents collaborated to transport her to the hospital, keep attendings and program directors apprised of the situation, and bring her snacks and comfort items to the hospital. Dr. M also received support from attending physicians at a neighboring hospital who helped coordinate her care. Essentially, she received a de facto version of PFA. However, given the evidence behind PFA and the unfortunate rate of violence against health care staff, institutions and organizations may offer training in PFA to ensure this level of support for all victims.

Multiple groups may take the lead to support a physician following an injury, including human resources, employee health, or other offices within the institution. The principles of PFA can be used to guide these employees in assisting the victim. Even if such employees are not trained in PFA, they can align with these principles by ensuring access to counseling and medical care, assisting with time off and accommodations, and helping the victim of an assault navigate the legal and administrative processes. Workers’ compensation can be a challenging process, and an institution’s human resources department should be available to assist the assaulted individual in navigating resources both within and outside of what they are able to offer.

2. Removing the patient from the psychiatrist’s care

During her recovery, Dr. M heard from a few peers that what happened was an occupational hazard. On some level, they were correct. While the public does not perceive a career in medicine to be physically dangerous, violence is a rampant problem in health care. Research shows that health care professionals are up to 16 times more likely to experience violence than other occupations; the odds for nurses are even higher.⁸

The frequency and pervasiveness of violence against health care professionals create an environment in which it can become an expected, and even accepted, phenomenon. However, violence cannot and should not be viewed as a normal part of workplace culture. A 2016 study by Moylan et al⁷ found that many nurses believe violence is part of their role, and therefore do not recognize the need to report such incidents or seek the necessary support. In other studies, only 30% of nurses reported violence, and the rate of reporting by physicians was 26%.¹⁴ This underreporting likely represents the role confusion surrounding whether caring for self or caring for the patient takes precedent, as well as normative expectations surrounding violence in the workplace.

It must be made clear to the victim that their safety is a priority and violence will not be tolerated. An institution’s administration can achieve this by immediately removing the patient from the victim’s care. In many cases, discharge of the patient from the clinic or facility may be warranted. A psychiatrist should not be expected to continue as the primary physician for a patient who has assaulted them; transfer to another psychiatrist is necessary if discharge is not an appropriate option. In a scenario in which a psychiatrist must maintain the treating relationship with a patient who assaulted them until the patient can be placed with another clinician (eg, as might occur on a unit with severely limited resources), staff chaperones can be considered when interacting with the patient.

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