Dr. Holt cited several instances with patients in which he, and even his family, were threatened with their lives. “The encounter that stands out most vividly in my mind is an adult patient who had a large osseous tumor of the face and who required a radical extirpation and a postoperative obturator,” he recalled. The patient had been diagnosed with paranoid schizophrenia and, unbeknownst to Dr. Holt, had stopped their medication after the surgery. “At one of the postoperative visits, this patient indicated to me that they had brought a gun to the appointment and planned to kill me and then my family,” he said. “Indeed, they did have a gun, and it required all of my persuasive capabilities to calm them down until security could arrive to secure the patient and the gun.” Dr. Holt continued to provide follow-up appointments to this patient, but these visits took place at the state institution to which they had been involuntarily committed.
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November 2022Between Physician and Patient
The doctor–patient relationship requires a minimum level of mutual trust and respect to thrive. Understandably, much emphasis has been placed on the patient’s feelings toward the physician. Physicians, conversely, are meant to remain emotionally neutral, at least outwardly. At the same time, however, they care deeply about what they do, and when their efforts are met with disdain, insults, and even violence, they may find it challenging to maintain a professional mien.
“In situations like this, it’s difficult to have recourse,” said one practicing otolaryngologist who chose to remain anonymous for this article. “You can’t yell at patients; you can’t easily fight back at negative online reviews. There are things that patients say or do to us that we would never tolerate from someone else in our daily or professional life, but we just bite our cheeks and care for the person in front of us, even as we grow to resent them. And it doesn’t feel good.”
Physicians, therefore, are left to reconcile that conflict between their internal, normal human response and their professional ethics. To be clear, the ethics code of the American Medical Association states that, should a patient exhibit disrespectful, derogatory, or prejudiced behavior, it’s the responsibility of the physicians to “… identify, appreciate, and address potentially treatable clinical conditions or personal experiences that influence patient behavior.” But when behavior becomes a safety threat, “steps should be taken to de-escalate or remove the threat.” Complete termination of the relationship is advised only when the patient will not modify threatening behavior that’s within their control.