My Patient Wants to Kill Me

A few years into my practice at the Veterans Affairs (VA) clinic, I was threatened by an angry patient when I had to discontinue his opioids. I placed a civil restraining order against him and when we met in court he admitted to the judge that stopping opioids improved his behavior. I discovered that the legal system could support the medical system's care of threatening patients but found the process stressful. My story outlines my journey and suggests that safety-net institutions such as the Veterans Affairs clinics might consider creating "patients of concern" panels where patients who have made threats meet with clinicians and administrators as part of ongoing treatment and, as a result, perhaps avoid courtroom visits. These panels could allow patients to air their grievances as well as see that a group of concerned clinicians are reviewing their care and making decisions as a team. Violence in the workplace, especially in health care, is on the rise. The stress this causes doctors, nurses, and staff is considerable. Leadership at safety-net institutions such as VA need to explore novel ways of addressing workplace violence.