Patients Killing Doctors
A discussion starting on a
bioethics listserv to which I subscribe. The opening of the thread and followed
by 2 responses. Would you want and are you in favor for your physician to have a gun available in his or her office accessible for self-protection? ..Maurice.
The current issue of the New Yorker (Aug. 25, 2014) has a man-bites-dog story "Under the Knife" (pp. 30-35) about an epidemic of doctor-killings by Chinese patients Physicians, of course, have been (mostly inadvertently) killing patients throughout the history of medicine. With a few notable exceptions ( e.g., Gabrielle Zerbi 1455-1505/9 who was killed by the sons of one in retaliation for the death of one his patients a Turkish Pasha), patients have seldom retaliated in kind.
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RESPONSE:
This happens in the United States as well.
There seem to be three major categories
The "political murder" of doctors who perform abortions. e.g.Tiller
The murder of psychiatrists.
http://abcnews.go.com/US/patient-kills-psychiatrist-murder-suicide/story?id=14155088
http://www.cbsnews.com/news/patient-who-killed-psychiatrist-now-accused-of-slaying-hospital-roommate/
The murder of doctors because of the patient's believe that the doctor caused a side effect.
Then I suppose one must also include what Grace Paley called "the little disturbances of man" where patients kill doctors over broken hearts. e.g.
Dr. Herman Tarnower,
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RESPONSE:
And maybe another category, related to chronic care of end-stage organ failure.
Nephrologist in MA shot over dialysis scheduling issue. Left paraplegic
Transplant surgeon in FL shot by patient.
Does anyone believe this will not be seen increasingly with "open carry" laws, and people bringing semi-automatic weapons on errands?
Graphic: From Google Images
posted by Maurice Bernstein, M.D. @ 12:06:00 PM
7 comments
7 Comments:
Maurice,
I am going to chime in here on this one. I saw the story on the Chinese doctors. The reason behind it is because the Chinese doctors are only paid about $800 (U.S.) a month. Healthcare is still the same as it was under the communist system.
With the new found wealth from capitalism, some patients can afford to bribe the doctors, which the doctors happily accept. One of the main reasons that the healthcare workers are assaulted is because patients (or their families) feel that they are ignored (whether because they paid and expect more or can't afford to pay and expect equal treatment).
As to the issue of guns, most people in favor of gun control confuse gun owners and criminals. Most gun owners are law abiding citizens. Most gun control advocates have never shot a gun.
There is also a hypocrisy there too: advocates like Rosie O'Donnell have armed security guards as part of her entourage. That means that there is a legitimate reason for her and her family to be protected with a firearm, but she does not want everyone afforded that right (only the rich). Most gun control advocates have NEVER shot a gun either.
The reason gun owners are so adamant about ownership is because they realize the purpose of the Second Amendment: to allow the citizenry to protect themselves from criminals, foreign powers, and our own government. Gun control advocates say that this will never happen. Recent events such as NSA wire taps, torture, Guantanamo, etc. prove otherwise. I grew up in a rural area area in Pennsylvania. I got my first gun (BB gun) when I was 6 years old. I was taught the correct way to handle guns.
Cars kill more people than guns, yet there is no push to ban cars.
I do not believe that open carry laws will increase gun violence, if anything it will decrease. FBI statistics show where there is increased gun ownership, crime is lower (because criminals are afraid of being shot).
Look at England where gun ownership is illegal. I always tell my friends across the pond that not being able to own a gun is a small price to pay to live in a country free of crime....
Countries like Switzerland require every citizen to own and keep an assault rifle in their house. That has always been a deterrent to foreign powers to keep from invading.
As to the point about semi-automatics; I comment Maurice's intelligence of not saying "assault rifles." A sharp shooter (think sniper) can kill more people with a single shot bolt action than a person with a FULL automatic. Lee Harvey Oswald killed President and seriously wounded Texas Governor John Connally with a 6.5×52mm Mannlicher-Carcano Italian Carcano M91/38 bolt-action carbine. Picture here:
If you ever shot a semi-automatic or full-automatic, you realize that without a lot of training, they are very difficult to control.
The Sandy Hook shooting started with Adam Lanza killing his mother and stealing her (legally purchased) guns. The issue here is mental illness. Psychiatrists by the nature of who they help put themselves at risk. They become at greater risk by proximity to (potentially) delusional patients.
David Berkowitz, also known as the Son of Sam, confessed to killing six victims and wounding seven others because he was commanded to kill by a demon that possessed his neighbor's dog.
When I was in college, there was an anti-gun rally. I asked the head of the anti-gun student group how many times that she shot a gun. She said never. I convinced her to let me teach her how to shoot, so that she would have credibility. I taught her the correct way. At the end of the day she asked when we could go again. She did not understand guns, she only knew the emotion assigned to them.
--Banterings
But Banterings, besides the issue of carrying guns in public as a general question, specifically in response to the question I asked: would patients be in favor or be comfortable to know that their physician has a gun present in the room, readily available, to respond to any life-threatening attack by a patient?
Oh yes..and another question: Should physicians tell their patients at the outset that there is a gun available? Or if asked by the patient should they answer?
This issue is of interest since in a couple U.S. states, legislation has been passed to penalize physicians if they, as part of taking a history, ask the adult patient or parent of a child patient if there are guns in the family's household. Keeping the presence of guns, by the patient, secret seems to be another issue in physician's attempts to provide medical care. Well, oh! until the patient uses the gun in the doctor's office. ..Maurice.
Maurice,
I have an oven, a chainsaw, a riding mower, weed wackier, and a car. When my kids are old enough they will learn to use all of them.
Why are guns singled out? What about cell phones microwaving our brains? Cars kill more people. Most physicians never shot a gun, so what are they going to tell a responsible gun owner.
Is it possible that this is just another symptom of paternalism?
Do you realize that the reason that people oppose it is because with EHR it is essentially the government creating a gun owner data base?
There is nothing that prevents a physician from educating ALL patients about guns.
I have no problem with a physician carrying a gun.
My Krav Maga instructor taught me, if you need a gun, the other guy will bring one. Take his.
I think that most physicians would be more worried about their colleagues with guns. I am sure that you can think of quite a few physicians who you would admit should not carry.
Could this be a part of a bigger problem with physicians about losing power? Even though pelvic exams are not required for birth control, at least 1/3 of physicians require them. Look at the backlash by physicians against recommendations against prostate exams.
Let's look at the deaths and take out the psychiatric patients; this is truly the wild card. There is no reasoning why.
Let's look at the Chinese physicians; they are partaking in an illegal activity by taking bribes. Again that puts them in proximity of a criminal act.
I also think that much of it has to do with physicians never apologizing. It is estimated that 40% of malpractice lawsuits can be avoided by a simple apology by physicians.
Do you think that a good doctor-patient relationship helps protect physicians? I think so.
Even if we took away all the guns, if somebody is so mad at a physician, don't you think they would still find a way?
--Banterings
Maurice,
I am very surprised that we do not see more "disgruntled employee" violence in the healthcare system. With all the stresses put on physicians, which is evident by the high suicide rate.
Perhaps this can be accounted for by the belief in "saving lives." Physicians, even though abused and angry at the system will not take retribution as other "disgruntled employees" do.
In other industries where you have workplace violence, the "disgruntled employee" is suicidal, but seeks retribution first. Many times it is "suicide by cop" or the person takes their own life before they are apprehended.
The disparity here may have insights on the patient dignity issue where providers' goal is saving lives at any cost and are blinded to quality of life issues (such as dignity).
This also made me rethink my previous statement about psychiatric patients being a "wild card." Perhaps some are, and some have been abused by the system and have no trust in it. Any provider can then be a trigger for the "sins of other providers."
Consider the case of Sampson v. Beth Israel Deaconess Medical Center AND Teen indefinitely detained in psych ward after parents seek 2nd medical opinion.
How do you think these patients and their families view the healthcare system after these abuses? Why did these abuses even have to happen?
Too often the solution is metal detectors, armed guards, bulletproof glass, etc. Our schools have been turned into prisons, complete with uniforms. Is that really a healthy environment?
Why not just teach people respect and how to be nice. Violence begets violence.
Power is of two kinds. One is obtained by the fear of punishment and the other by acts of love. Power based on love is a thousand times more effective and permanent then the one derived from fear of punishment. --Mahatma Gandhi
I object to violence because when it appears to do good, the good is only temporary; the evil it does is permanent. --Mahatma Gandhi
--Banterings
This is a very difficult question. There is certainly the consideration of a doctor being harmed by a patient. However having doctors armed can be seriously harmful to patients. A lot depends on the type of person that the doctor is. If they are a toxic personality then they can use the gun to do harm without firing a shot and without even drawing out of their pockets.
Being armed gives a person the means to do harm. The only thing that is needed to cause a serious fear reaction in the other person is criminal intent. That is a mental condition and very difficult to prove.
A greedy doctor or a toxic doctor (looking narcissistic supply) may hold criminal intent at the time they discuss any negative effects of drugs prescribed or surgery planned. This can have a devastating effect.
If the patient is threatened mentally by the doctors, then the intent of a doctor who is armed, will caused fear in the patient because they will become insightful of some danger that they cannot identify. It at the same time the doctor discusses something with the patient that is related to their condition or treatment then the patient may wrongly associate the fear with the suggestion. People commonly use emotion that is concurrent as evidence for an idea.
In this case the patient may believe that something about their condition or treatment may cause them harm or death. This would be an extreme nocebo effect that could do a lot of harm.
An optometrist, who I believe was armed because fear is not created where there is no danger, made some vague suggestion that with these glasses I would be seeing things. It was aimed to destabilize me. I saw through the problem and had no ill effects but I could see that this could have a bad effect on someone unsuspecting of the deceit.
Here I discuss the basic cheat
https://kyrani99book1.wordpress.com/chapter-1/ when this involves a doctor the effects on a person unfamiliar with the cheats can be very bad.
Kyrani99
The title "Doctor" has nothing to do with education or degrees he or she has earned. Doctor means you put the well being of others in front of your own. I am a chronic pain patient with a diagnosis verified by three doctors. Today I sought relief with a pain management doctor. Instead of relief he told me about how he has rules he has to follow or they could take his practice away from him. This is sadly the norm, rather than the exception. Diabetics are given insulin and not called insulin addicts. He wants me to jump through hoops that, I am physically unable to do, in order to protect HIS practice. He doesn't deserve the title "Doctor." Chronic pain patients are abused due to this "war on drugs" and left to languish in unfathomable suffering. It is only a matter of time until the first person living in agony, with nothing left to loose, kills one of these "doctors" before ending his or her own misery. Once that happens the floodgates will open. Pain doctors might as well carry guns, they are just cops in long white coats.
-Pissed off in Pain
But Society through their state government and state medical boards in the United States is currently putting pressure on doctors regarding the further regulation of their narcotic pain treatment of patients. Is this the fault of the physicians or is this the fault of Society and their legislators? ..Maurice.
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