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How to avoid a violent attack by a patient

Dr Josh Hill recalls being attacked by a violent patient and looks at how the situation could have been avoided.

The last thing I remember before being attacked is sitting next to the patient on the sofa, him talking to me. Then wallop!

Fists were battering both sides of my head. I was curled up in a ball, inadequately trying to defend myself against a hail of punches. Then I was on the floor, shouting for help. I managed to kick him away, but seconds later he was advancing on me again.

Dr Josh Hill was attacked by a patient while carrying out a mental health assessment in the man’s home

Making my escape
Just then there were more shouts and the thud of impact as the bodies of two burly men collided with the patient and dragged him off me. His relatives had dashed in from the next room.

Instinct took over as I grabbed my glasses off the carpet with one hand, snatched up my doctor's bag in the other and made off like a sprinter from the starting blocks. I heard enraged cries of 'Get him! Get him!' shouted after me.

I hurled myself in front of an oncoming car across the road to where my car was parked and drove off, hyperventilating. My arms were shaking violently as I drove to the surgery, inspecting the damage to my face in the rear-view mirror. I was very late for our practice meeting.

The patient's sister had come to see me earlier that day. She was very upset and begging me to help her brother, who was saying 'mad things, not making sense, paranoid'. He had assaulted two family members the previous night.

The police were called and had taken him to A&E for psychiatric assessment, but he was discharged a few hours later. The family did not know what to do.

Making an assessment
I rang the nurse at our local crisis team, but he cut me off with his first question: 'Have you actually been and assessed the patient?' The rest of our exchange did not go well. 'No, I've spoken to him on the phone and he's clearly extremely unwell,' I replied.

The nurse then pointed out that I needed to have seen the patient before the crisis team could accept my referral. Seemingly deaf to my response that the patient clearly needed a psychiatric assessment and had already assaulted two people, the nurse insisted an assessment was needed.

That was how I came to be standing in the hallway of the patient's home with a frantic family trying to persuade him to 'talk to the doctor'.

When he finally consented to see me he talked and talked, becoming increasingly confidential, revealing a seething pit of paranoid delusions and self-hatred.

Several times he had to stop as his emotion overwhelmed him. He sat, fighting it back, jaw and fists clenched, perching on the very edge of his chair with his feet pressed hard into the carpet. Then he attacked me.

Why, I asked myself afterwards, did I put myself in such a dangerous situation? It was a combination of recklessness, pride, naivety and haste. I was inspired and swept up by the case and there was a family who desperately needed my help.

I was fired up with adrenaline and acted recklessly, rather than adopting the cooler, thinking, calculating approach essential to cases such as these.

I had relied on my status as a doctor to protect me, just as it had done before in risky situations I had stepped into.

I had never been assaulted by a patient before or heard any accounts by those who had, so I didn't have that instinctive, visceral fear. I was also too naive back then to argue with the crisis team, even though what the nurse said did not sound right to me. I learned in retrospect that it was not right.

I had, actually, fleetingly wondered whether a police presence would be preferable. However, contacting the police to arrange this would have been an impossibly time-consuming exercise for a busy GP with an hour to go until the practice meeting. Surely it would be easiest to just go and sort the situation out by myself?

The aftermath
The patient was sectioned the same day, my assault seemingly prompting a much-needed burst of action from our community mental health team.

My partners were shocked, understanding and sympathetic. They offered me as much time off as I needed to recuperate, and I took a few days.

The experience made me more aware of how volatile are some of the situations in which we find ourselves as doctors. The majority do not cross that invisible threshold into violence. It is impossible, however, to predict exactly when they will and one can be completely taken by surprise.

I now advise a low threshold for enlisting the help of others before getting involved in a risky situation. Don't be swept along by adrenaline and slow down if you feel pressured into trying to deal with a situation like this in a hurry.

  • Dr Hill is a GP in Tottenham, north London

How to avoid an attack

Don't:

  • Let wanting to help overwhelm clear thinking.
  • Assume that your doctor status is enough to protect you.
  • Think that as you have never been assaulted, it will not happen to you.
  • Put saving time before your own safety.

Do:

  • Question other professionals' advice if it seems unsound.
  • Bear in mind that a volatile situation could turn violent.
  • Avoid dealing with high-risk patients on your own.
  • Stop to consider the most appropriate response to a crisis.

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