The Doctor Death Wish: Why are so many health workers victims of violent attacks?

Last week, 50-year-old Paul Warren Pardus decided to express how he felt about the medical care being provided to his ailing mother. So he shot her doctor. Then he barricaded himself in his mother’s room at Johns Hopkins Hospital. When police found him, he had shot both himself and his mother to death. Her surgeon, Dr. David B. Cohen, had been shot in the abdomen and is expected to survive. According to the Baltimore Sun, Pardus believed that Cohen was to blame for his mother’s paralysis. (Unfortunately, I can’t seem to find enough information on the case to determine whether this accusation had any basis in fact.)

Assaults on doctors are not uncommon. The National Institute of Occupational Safety and Health keeps track of workplace assaults that are severe enough to prompt the victims to take time off of work. According to NIOSH statistics, a whopping 51 percent of these attacks are directed at health care workers. General practioners, ER docs, and psychiatrists, research shows, are at particular risk.

Such staggering statistics become less surprising when you consider what it’s like to be a patient. Doctors see us when we’re ill or in pain, when we’re vulnerable, when we feel as though our worlds are spinning out of control. Even the best of doctors can’t ensure perfect–or even positive–outcomes. Add to that the fact that medical care can often feel impersonal and that doctors are human (and therefore sometimes do make mistakes). It’s not altogether shocking that patients might occasionally take their anger or sadness or frustration out on their medical caregivers.

Of course, in hospitals all across the nation, patients experience setbacks and losses every day, and most of them don’t put bounties on their doctors’ heads. So what distinguishes a violent patient from a plain ol’ unhappy one? 

A study published earlier this year in the Journal of Clinical Psychology in Medical Settings provides some answers. A team of researchers from the University of Miami and elsewhere studied more than 2,000 people, including healthy and unhealthy members of the community at large as well as patients in rehabilitation for ongoing medical problems. The subjects filled out a bundle of paperwork, including various assessments of physical symptoms, pain, depression, anxiety, hostility, personality, substance abuse, trauma history, family dysfunction, job dissatisfaction, and more.

Along with all these questionnaires, each subject responded to a single item, using a four-point scale to indicate whether they wanted to kill their doctors–and just how strong that wish was. Among those pulled from the general population, 1.6 percent of healthy subjects and 4.4 percent of those with chronic health problems said they wanted to kill their doctors; 5.5 percent of those in rehab expressed the same desire.

Then, the researchers started looking for correlations. The most significant predictor of an expressed desire to kill a doc was a patient’s score on the borderline personality scale. Patients who had more borderline traits–including emotional dysregulation, self-destructive behavior, and a tendency to engage in interpersonal conflict–were more likely to want their doctors dead. But such pyschopathology wasn’t a necessary component of what the researchers termed the “Kill MD wish.”

Patients who were extremely dissatisfied with their doctors and were involved in some sort of litigation against them were also more likely to want their caregivers dead. This was true even of patients who otherwise seemed to be in perfect mental health. (The doctor dissatisfaction scale used in the study assessed four types of grievances: “perceptions of doctors as unempathic, perceptions of failed treatment, perceptions of being forced into undesired treatment, and actual feelings about doctors,” according to the paper.) Patients with more severe pain, particularly back pain, were also more likely to want to kill their docs, but this factor was not as predictive as the others.

The study, of course, has some limitations. Most notably, saying you want to kill your doctor is not at all the same thing as actually trying to do it. But the bigger problem, I think, has nothing to do with the study design. Instead, it’s this: What on earth do you do with the findings? Sure, it’s important to understand the nature of the problem, but can we translate the researchers’ conclusions into practical solutions? In the paper, the scientists write: “[O]ur data may be clinically useful in that the identified predictors could be used as a screen for identifying patients who harbor hostility toward doctors.”

Pardon me if I seem dubious. Really–you’re going to give all patients a battery of tests to see whether they wish their doctors harm? (“Well, hello, Mr. Smith. Are you excited to be leaving the hospital today? Do you have someone to drive you? Oh, and, by the way, do you want to kill Dr. Jones?”) And even if you did, would it really do you much good? Think of the enormous numbers of false positives it would generate. Though I don’t have any stats–or think anyone’s even collected them–I’d bet bundles of money that the overwhelming majority of people who say they want to kill their doctors never make even a half-hearted attempt. (Plus, patients who are truly planning an attack might not respond honestly to such questioning.) Hospitals can’t start taking out restraining orders on every patient who’s had a bad outcome.

The best we can do, I suppose, is try to understand what kinds of patient experiences are the most deeply traumatizing. What specific factors are most predictive of doctor dissatisfaction? Are there things that doctors and hospitals can do to address these factors? There will always be mentally unstable patients with grudges, and we won’t ever be able to utterly eliminate the occasional wish to do harm to a doctor. But if we can figure out what factors are most important to patient satisfaction, we’ll be able to improve care across the board–a worthy goal in itself–and perhaps keep some patients from feeling as though their only recourse is violence.

ResearchBlogging.org

Reference: Bruns, D., Fishbain, D., Disorbio, J., & Lewis, J. (2010). What Variables Are Associated With an Expressed Wish to Kill a Doctor in Community and Injured Patient Samples? Journal of Clinical Psychology in Medical Settings, 17 (2), 87-97 DOI: 10.1007/s10880-010-9190-7

Image: Wikimedia/Jacob Windham

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3 Responses to The Doctor Death Wish: Why are so many health workers victims of violent attacks?

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  2. aidel says:

    Are you kidding me? Although I acknowledge the seriousness and immorality of physicians being victims of violence (and victimized by people whom they are trying to help, no less), it is not doctors but NURSES who bear the brunt of the rage of disgruntled and/or insane patients and family members. Especially in ERs and ICUs, nurses ROUTINELY are spat upon, kicked, punched, bitten, grabbed, slapped, pushed, cursed, threatened, harassed and insulted. What’s worse is that it is not at all uncommon for not only patients/families but also PHYSICIANS to be the perpetrators of violence against nurses. I don’t know a single nurse who has not at some point in his or her career been the victim of a physician’s rage, most often verbal abuse but it is also not uncommon for physicians to throw things at nurses, including (in one case) a *used* scalpel. For nurses, this is considered a routinely encountered “occupational hazard.” And I don’t recall even seeing the word “nurse” a single time in this article. Yet another unfortunate example of how individual human value is inextricably linked to an individual’s SES.

  3. b says:

    “Hospitals can’t start taking out restraining orders on every patient who’s had a bad outcome.”
    They can if docs start building a file on all patients that do not improve after they treat the patients like their malpractice lawyer and pretty pharma rep tells them to. Of course mp lawyers have the doc’s best interest at heart, unlike the evil patient who just wont get better.

    “The best we can do, I suppose, is try to understand what kinds of patient experiences are the most deeply traumatizing. What specific factors are most predictive of doctor dissatisfaction? Are there things that doctors and hospitals can do to address these factors?”
    Injecting a drug into an iv of a patient that she is documented to have serious allergy to, lying to patient and saying it is something benign, then getting angry when the pt has to go for emergency care- doctors did this right in front of the patients husband who is a veterinarian. It took everything for husband not to get violent. He talked to another vet that had an ailing mother, and another doc did something similar to her. Sounds pretty common. Another patient was nearly put in restraints for quietly asking if she should require the ER for a severe latex reaction of her skin to a jejenostomy tube. She was accused of putting fecal matter on the tube to cause her own infection/inflammation. This is true I saw it firsthand. They seem compelled to blame patients that are not improving to protect their liability.

    In one university teaching hospital, the head surgical nurse committed suicide because he was constantly the brunt of doc rage for no reason. He was the guy that trained everybody, well liked and very competent. The day he did it nobody cared either (I do), wow. Another example was a nurse that had things thrown at her and constantly was abused by the doc at her job. She shot herself outside of a staff party…

    When giving lectures to students in the university teaching hospital, one doc would say as part of lecture for every rotation that came through- “blame the nurse if you make a mistake, avoid legal liability” if patients have an intractable disease, reputation management consists of framing the patient as not of sound mind, or avoiding the patient at all costs, many times both techniques are used. These true examples all happened at different hospitals in the NE and SE USA that are considered top class facilities.