Returning to work after a patient assault

An institution’s administration should provide support if the psychiatrist chooses to press charges. At the core of our ethos as physicians is “do no harm,” and for some, the prospect of filing charges may be a difficult decision. However, health care professionals do not have an ethical obligation to put themselves in danger of serious bodily harm.¹⁵ While there is no one-size-fits-all answer to the question of whether or not to press charges against a patient who has committed an assault, the Occupational Safety and Health Administration considers the perception that violence is tolerated and victims are unable to report to law enforcement an organizational risk factor for workplace violence.¹⁶

As leaders in the workplace, physicians should set the precedent that violence will not be tolerated by reporting incidents to police and filing charges when appropriate. In the case of Dr. M, she received full support from her institution’s administration in filing charges against Mr. B due to the specific details of the assault.

3. Easing back into the environment

Despite assurances from her superiors that she could take time off, Dr. M wanted to return to work as soon as possible. She considered the balance between her physical injuries and desire to return to work and ultimately returned to work 5 days after the assault. She did well with supportive measures from administration and other staff, including the use of technician escorts on the unit, peer support, and frequent communication with and check-ins from management.

The decision on how quickly to return to work should always lie with the individual who was assaulted. The administration should offer time off without hesitation. Victims of an assault may feel overwhelmed by 2 diverging paths on how to return to a traumatic environment: avoid the location at all costs, or try to “face their fears” and return as quickly as possible. Research from outside medicine indicates that the timing of returning to work after a traumatic injury may not be nearly as important as the method of returning, and who makes this decision.¹⁷ Predictors of return to work after an assault include not only the severity of the trauma and amount of distress symptoms, but also any actual or perceived injustice on the part of the victim.¹⁷ Although this study was not specific to health care employees, it suggests that overall, an employee who does not feel a sense of control over their choice to return to work could perceive that as an injustice on the part of administration, leading to decreased job satisfaction.¹⁷

A study by Lamothe et al¹⁸ that was specific to health care professionals found that despite the importance of self-efficacy for the assault victim, perceived organizational support had an even greater protective effect following patient violence. Additionally, monitoring for signs of distress among victims after an episode of violence could prevent further violence by reducing the risk for subsequent victimization.¹⁸ This highlights the need for leadership of an inpatient unit to be keenly aware of how an assault on a psychiatrist or other health care professional may change the work environment and create a need to help staff navigate the new normal they may face on the unit.

Continue to: Finding long-term support