Tuesday, September 05, 2006

Risky Business

You probably know that Steve Irwin, the Crocodile Hunter, was killed this past weekend by a sting ray in the course of filming a show.

What you may not know is that Dr. Wayne Fenton, a schizophrenia researcher at the National Institutes of Mental Health, was killed this weekend by a schizophrenic patient he was seeing in his private office.

I didn't know Dr. Fenton, I don't think I even knew of him, but I learned of his death at a Labor Day barbeque I hosted, from one of my neighbors who is also a schizophrenia researcher and who did know him.

My husband asked me last night, "Don't you worry about being alone in your office with patients?" I don't. There's only so much I can worry about, and for the most part, my patients constitute a rather tame crew. My husband says that when he lets himself think about it, he does worry about me.

Even if I don't wrestle with crocs for a living, the reality remains that people with psychosis can behave in unpredictable ways. As a child, I lived across the street from a neurologist. His office was across the hall from a psychiatrist and one day, a patient walked in and shot and killed the psychiatrist. Needless to say, my mother thought I should consider another career.

I once briefly treated a patient who was preoccupied with thoughts of killing his former psychiatrist and who had previously been banished from a local psychiatric institution for threatening psychiatrists there. He was psychotic, bizarre, violent, and needy. After a few months, I sought consultation and, as a result of this, told the patient I would not continue to see him in my office-- the consultant had suggested that it was too intimate and secluded a setting-- but that I would be happy to see him at the clinic where I work. The hours I'm at that clinic conflict with the hours this patient worked, so while I made the offer, I knew it wouldn't fly. When I told the patient, he became angry and began pacing around my office and making threatening gestures. I went into the hallway, and to get him to leave, I had to have the police come. He phoned later and wished me a doomed future-- perhaps the closest anyone has ever come to the "F*** Off Rule" SHP talks about in her post today. Foofoo added to SHP's comments with a horrifying story of how he'd been assaulted, bitten, and broken by a violent patient he'd pulled off an intern. I'm impressed by his bravery, saddened for both of them at the violation. I'm not so sure I could have gone on working -- at least not in that setting-- in the face of such horrors.

I didn't know Dr. Fenton-- this story isn't really mine to tell but from the perspective of a fellow psychiatrist who is left to wonder a bit about issues of safety, and to feel badly for my neighbor who is distraught. My heart goes out to Dr. Fenton's family and friends, and somehow this all feels a bit closer to home than the other stories I've heard this weekend.

Dr. Fenton remembered across the blogs

17 comments:

NeoNurseChic said...
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Dreaming again said...

I am soo soo so sorry.

My mother taught in patient in a school for the emotionally disturbed. (not sure if that's the pc term for it now, that was the term in the 80's)

I worried constantly for her safety, she had her finger broke by a 10 year old girl. She was shoved against a black board for telling a thirteen year old boy that 'their' is 'they're' in the sentence 'they're wanting to go home' and there were a few more incidences.

She had far more violence with the gifted kids than the learning disabled kids.

Sometimes I wonder ..what happened to those kids who attacked her then ... where are they now? Are they ok? Did they get the help they needed as kids? or are they hurting someone else as adults?

Shiny Happy Person said...

Sad. Should these things put me off? I'm glad they don't - it reinforces my conviction that I am doing the right job for me. But I do sometimes wonder if I have an abnormally low sense of self-preservation.

I would be interested to know what the figures are for murders/mainings of psychiatrists by patients vs. other doctors by patients. As I said in my post, it is certainly not just psychiatrists who are subject to abuse and violence by patnets, and in some I think we're safer because whilst we deal with dangerous people, we are equipped to deal with that to some extent. Of course, there's not much you can do against a loaded weapon. There are, of course, measures you can take to be safe, but as with driving a car, or avoiding getting mugged, or anything else, there is never any guarantee. Am I too blase?

ClinkShrink said...

Interesting---in all the medical literature on PubMed, when I do a search on "doctor-patient violence" it only turns up 22 articles. Only one of those articles is about preventing violence to physicians.

It appears that in medicine we bear the responsibility for assessing risk and preventing violence to everyone but ourselves. Pediatricians must diagnose are report child abuse. Family physicians and ER docs must monitor and assess for domestic violence. Psychiatrists must assess and report patients who are dangerous to others. But what about our own safety?

This may be a blog posting all to itself, but I think that Dinah has touched on a very important issue. Free society treatment settings do not adequately address security needs for those working there.

By the way, here's the one relevant article I found on PubMed (availabe online in full text):

Our white coats are not armour

Thanks for a great post on an important topic.

And the Labor Day picnic was delicious.

a psychiatrist who learned from veterans said...

The odd thing about this to me is that it happened in his private office on a weekend. That suggests he had some degree of trust in this patient or, at least, lacked mistrust. The patient had resources to pay but perhaps that was Medicare. An analyst told me that most people don't kill their doctors, when they are inclined to, because of the legal consequences. All doctors enter into others personal space. There was a Rio Grande Valley OB that was gunned down by a drug lord after his sister died in an obstetrical event. It has been a price people pay, at times, in trying to do something meaningful. We pay, in a sense, as G-d, the omnipotent mother, though we are only human.

Sarebear said...

I've wondered about mental health professionals' safety too.

I think I first wondered about it when watching a movie scene that had a patient attacking a psychiatrist in a psych unit hallway and another patient gets the attacker off of her.

Then I thought, well, in a hospital, at least outside a private room perhaps there'd be help, but in a private practice . . . not so much. Maybe I wondered if shrinks kind of have a can of pepper spray around or something, but I didn't really think so.

I think it's cool that people choose to help people, especially when so many others shun them, even if just for being a little bit different. That people choose to help people in ways that may put them sometimes at risk. That is impressive, to me, even if the likelihood isn't high, it's still impressive. To work with such . . . sometimes uncooperative and sometimes difficult folk, and some with the potential for violence, too, and some who may be trying on one's patience, such as myself . . . well, that's not a small thing. And I keep coming back here, because I enjoy the perspective you bring to things. And the things you guys have to say.

Even if I'm afraid I'm being shunned here, too. I guess I'm hyper-vigilant/hyper-sensitive to that (see my post today about that, if you want to bother).

Anyway, my thoughts and prayers are with the family and those who knew him, at this time.ww

Sarebear said...

Um, upon re-reading my comment, it might be read that I am saying, "such as myself" regarding ALL the things in that sentence. I'm not a violent person, although I suspect I'm a trial to people's patience, sometimes.

I try the hardest I can, so I wouldn't say difficult or uncooperative, either, but that's more in the eye of the beholder, I guess.

But when I reread that i was like, OH NO. I'm not violent. Lol. The two times I've been beaten up (well, not counting my mother hitting me as a teen), I told my hands to form fists and hit back, but all they did was wave around. See? Now that makes it sound like I hit my mother back, and I can't stand that thought either. I didn't hit back then either.

foofoo5 said...

There are inumerable variables in the prediction of violence. I have seen numerous algorithms, none of which seem to provide much critical assurance. I suspect that personal experience & acute perception (and I'm not referring to Malcolm Gladwell, who seems to have skipped Statistics 101) does play a role, and in the uncontrolled environment of a public clinc, I believe in a pro-active role for my own safety. Regardless, so many variables turn out to be unpredictable and, in the end, uncontrollable. This is a great post, Dinah, and I agree with ClinkShrink, that it is a complex issue to be explored further.

NeoNurseChic said...
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Roy said...

I knew Wayne only peripherally, back in the day when I was an aspiring schizophrenia researcher. It is indeed sad, and a shock, that he would die at the hand of one he was trying to help.

I remind you, though, that people with severe mental illness are much more likely to be the victims of violence than the perpetrators.

jw said...

roy makes a good point and one I've seen made many times by advocates for patients. The mental health patient is indeed more likely to be a victim of violence than an offender, at least for the severe ones and quite possibly for all.

Understanding violence is one tough and nasty thing. Often it requires understanding things which seem highly improbable.

I don't pretend to know what psychiatrists can do to reduce their risk. We do not yet know enough about the whys and wherefores of violent behavior.

Turboglacier said...

The worst that's happened to me, in five years of inpatient psychiatry, is to have blood thrown on me, my tie grabbed, and to have ducked a few punches (and tolerated innumerable verbal threats.) But I have seen a nurse with her foot broken into pieces... an aide with his trachea crushed... a security officer with face pummeled to a swollen black-and-blue charicature of itself... and more. The security officer did not "fight back" because he was, probably correctly, afraid he would lose his job if he did.

I have struggled for years with the dilemma of how to keep staff (including me) safe, while not furthering the stigma of mental illness. The fact is that most mentally ill persons are nonviolent. The other fact is that my facility houses enough of those who ARE violent to make it an extremely dangerous place. I have often wanted to write a letter to our local paper thanking our staff for their bravery and courage in a thankless and hazardous job-- but have stopped because I predicted a backlash for the suggestion that psychiatric clients can be violent.

And I decided, recently, to stop wearing ties to work.

a psychiatrist who learned from veterans said...

Your blog post starts off with Steve Irwin and Wayne Fenton, the first killed by being counterphobic with wild animals, the second killed (?) by being counterphobic with patients. That may be a facet of our work.

Someone left a really sweet note: 'Anyway, my thoughts and prayers are with the family and those who knew him, at this time.'
'Thoughts' nice! Without 'praying for the departed' though we signal we really don't believe in prayer; 'we are simply being neither cold nor hot.'

ClinkShrink said...

Welcome back Turbo; as a cat person in recovery I would like to send my regards to 9.

Analogous to the tie issue, I don't wear necklaces or earrings to work. (I did have a nice pair of gold hoops with 'breakaway' clasps, but...they broke.) I'm always amused when I see people walking around the facility wearing their ID's on a lanyard around their necks. Nothing like providing your own ligature.

NeoNurseChic said...
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Shazer said...

I agree with Shiny Happy Person. Far from scaring me away from this field, it is stories like these that make me want to do it with an intensity I can't explain. Maybe I myself am crazy...or maybe I just have a passion for psychology that can't be dimminished.

Roy said...

FYI: NIMH has put up a page about Dr Fenton.