My Patient Wants to Kill Me

Area of Science:

• Healthcare Management
• Patient Safety
• Medical Ethics

Background:

• Workplace violence in healthcare settings, particularly in safety-net institutions like Veterans Affairs (VA) clinics, is a growing concern.
• Clinicians face significant stress and potential danger when managing patients exhibiting threatening behaviors, especially during sensitive treatment changes like opioid discontinuation.

Purpose of the Study:

• To explore the intersection of the legal system and healthcare in managing threatening patients.
• To propose an alternative, non-legalistic approach for addressing patient threats within healthcare institutions.
• To reduce workplace stress and violence experienced by healthcare professionals.

Main Methods:

• A personal narrative detailing a clinician's experience with a threatening patient and subsequent legal intervention.
• Analysis of the effectiveness and stress associated with using the legal system for patient management.
• Proposal of a "patients of concern" panel as a multidisciplinary, team-based approach.

Main Results:

• The legal system can provide a framework for managing threatening patient behavior, though it is a stressful process for clinicians.
• The patient acknowledged improved behavior after opioid discontinuation in a legal setting.
• The proposed "patients of concern" panel could offer a structured environment for patient grievance and collaborative care review.

Conclusions:

• Safety-net institutions should consider implementing "patients of concern" panels to proactively manage patients who have made threats.
• Such panels may help de-escalate situations, improve patient care, and potentially avert legal interventions.
• Addressing workplace violence requires innovative strategies and institutional support for healthcare staff.