Violence Against Health Professionals

The Navy Yard killer was a paranoid schizophrenic. Medical professionals suffer their share of violence from these patients, too. This is my recent experience. Are you at risk?

The Threat

The woman said to me, “Tell your husband to call or I’ll take this to the courts.” This sounded menacing. She followed up with: “My children have been taken away.”

My husband is a cardiologist. I had no idea how her warning about court action and her children being taken away could have anything to do with a doctor who specializes in hearts. My husband decided to find out more. It surprised him when she accused him of altering his voice over the phone. She said he was another doctor whose first name was also Tom, but a different family name. In short, she thought my husband was imitating someone else.

The other Doctor Tom

My husband called the office of the other Doctor Tom, a physician in a totally unrelated specialty to cardiology. The physician’s assistant told my husband that this woman had been stalking her employer for years. This is the story:

The other Doctor Tom saw this woman in 1998 and only once for follow up.

For reasons that are unclear, except for apparent psychiatric disease, the woman thought she had children with the other Doctor Tom and that they had taken them away from her.

Since 2002, she had been harassing him, calling his office many times as well as his home. She had even talked to his children. At Christmas, she brought gifts to his office for the children that she thought were hers.

Her medical records indicated that she had a diagnosis of schizophrenia.

The psychiatrist’s opinion

A psychiatrist was consulted as to the danger this woman posed to the other Doctor Tom. He was told she had “fixed delusions” and presented little threat. Reading between the lines, to me this indicates there is unlikely to be a problem but if there is, it could be lethal. She thinks the other Doctor Tom did her wrong, in other words she is a paranoid schizophrenic. This condition is characterized by delusions, often that someone is trying to harm them.

The other Doctor Tom blocked her calls from his office and home phone. It seems that at this point my husband became the substitute for her unwanted attention.

What should we do?

This engendered a discussion between my husband and me. Now, that she knew our home phone number, it would be easy for her to come to our house if she made an effort. What were the chances that she might do this or worse?

Wayne Fenton, a schizophrenia expert, was found dead in his office at the hand of his 19-year-old schizophrenic patient in 2006. Would statistics suggest we needed to take this seriously?

The data

A recent review entitled “Violence Against Mental Health Professionals: When the Treater Becomes the Victim” published in Innovation in Clinical Science in 2011 gives considerable information.

A survey of 115 psychiatrists indicated that 72% of patients with assaultive behavior were schizophrenic. Though violent crimes are normally perpetrated by men, the presence of a psychiatric disorder reduces this preponderance. Female patients are just as likely as males to be violent and the features of the violence are the same.

Further, the assaults are often against family members of the doctor in his or her own home. One-third of these attacks resulted in physical harm. Young psychotics are more likely than older ones to perpetrate a violent assault. Those with a history of violence will be the ones most likely to commit it in the future. This correlation is so strong that past violence is linearly associated with future violence.

A disturbing part of the literature though is that often the attacks have no rational basis. There is no clear way to predict where or when they will occur or even to whom. They could simply be the result of psychosis, for example hallucinations or paranoid delusions. Substance abuse often accompanies assault.

Although doctors in any specialty are targets, other health professionals are victims more often. The United States Department of Justice's National Crime Victimization Survey showed that from 1993 to 1999 the yearly rate of nonfatal, job-related violent crime was greater for nurses, and about four times higher for psychiatrists, and mental health professionals and mental health custodial workers:

Data from “Violence Against Mental Health Professionals: When the Treater Becomes the Victim”

My take

Initially, I thought my husband and I were at risk, and I still do. After contemplating the data above, I am somewhat relieved for us, but still have heightened awareness that certain medical caregiver groups are at high risk.

Instead of “buyer beware,” it is “health care provider beware.”