On aggression

Incident #1: 3 am.
CC: Rule out globe rupture.

Intoxicated 20 year old man, when told he didn’t need surgery called the resident a “f-ing ch-nk” and threatened to “sue her”.

Incident #2: 2 pm.
CC: Decreased vision “post-op”

45 year old man, punched a resident without provocation.

Incident #3: 5 pm.
CC: Can’t “focus” after head injury.

36 year old man told that his “nystagmus” was voluntary and not physiological. Yelled at the physician to go back to school. Shouted to the patients in the waiting room he wouldn’t even bring his dog here.

*

These incidents happened at different times to different people. Thankfully, there was no lasting damage. But it quietly shook the (perhaps, naive) implicit trust I had in the physician-patient relationship, that somehow, because you are trying to help someone, they would not deliberately harm you or be hostile towards you.

In my sheltered world, I’ve never heard a racial slur said to me. And I never thought that I would hear it while providing medical care to someone. But the words were the least of it, he had torn his hospital gown off, and he was towering over me and I was all alone. And after security came, after he returned to ER, after all the detailed documentation in his chart… The overwhelming thought was not – how can someone do this to me or what consequences should he bear or even that the emergency department did not do due diligence to warn me… But blaming myself for being vulnerable.

I had tucked away this incident that had happened more than a year ago. But after witnessing incident #3, not as the direct target of those comments, I was reminded of that moment when I was powerless. Although my staff knew in advance that this was a potentially challenging situation and had asked me to stay in the examination room, all he could do after the confrontation was spend half an hour documenting what had happened.  He was clearly shaken, but he went on seeing the remaining patients.

In medical school, the only “training” I recall in dealing with these situations was a brief clinical exam station in diffusing an “aggressive” patient. The station always ended with the patient being calm again, and you got full marks for remaining professional….But no one ever touched on the aftermath.

Admittedly, these are rare encounters.  It is hard to prepare for them, and hard to process after.  Perhaps, the approach should be similar to what my staff did.  Be aware of potentially risky situations, be objective, and focus on the other patients who need your care.

 

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