Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

When the doctor becomes the victim

Shaili Jain, MD
Physician
April 13, 2018
Share
Tweet
Share

Years ago, the police brought a middle-aged man to the hospital for evaluation on a day when I was the on-call psychiatrist. Earlier that morning, the man had walked into his psychiatrist’s office without an appointment asking to see his doctor immediately. When his demand was not met, he caused a raucous in the waiting room, tossing over tables and chairs and alarming the other patients. He refused to leave, and the police were called.

When I met him, he was red-faced and incensed. I listened to him rant about his psychiatrist, alleging he was responsible for the breakup of his marriage. During a recent couple’s session, he claimed, a clinical observation about the couple’s relationship had prompted the wife’s decision to leave. “I want to ruin his life the way he has ruined mine!” he told me, eyes glaring.

Working with the mentally ill requires a unique form of bravery. One must be willing to wade into the intimate and dark recesses of people’s psyches in order to help them even when it gets messy. I knew the man’s psychiatrist to be a professional, intelligent and sensitive doctor. My hunch was this: The patient’s marriage break-up was so impossible for him to accept that he needed someone else to bear the brunt of his shame and rage.

My somber task that day was to make a risk calculation. How dangerous was this patient? How likely was it that he would actually harm his psychiatrist?

On March 9th, 2018, at the Pathway Home program for returning veterans located on the grounds of the Veterans Home in Yountville, California, Christine Loeber, a social worker and the program’s executive director, Dr. Jennifer Gonzales, a psychologist who was six months pregnant and Dr. Jennifer Golick, the program’s clinical director, were killed by a former patient.

For social workers, psychologists, mental health nurses, and psychiatrists everywhere the Yountville tragedy is igniting conversations about the risks of being intentionally harmed by the very people we are trained to care for.

For many reasons, these conversations are hard to have.

First, mental health professionals have legal, ethical and moral responsibilities toward their patients. Years of training have us primed to act in our patient’s best interests. This philosophy is turned on its head when one is deliberately threatened by a patient. All these aspects leave a professional in murky and unchartered territory.

Secondly, it is how easily lines can blur. It is true that most individuals with serious mental illness are not dangerous. In fact, these individuals are more likely to be the victim of a violent act than a perpetrator. Still, caring for the mentally ill, by its nature, requires compassion for a clientele whose pathologies can render them mistrustful, belligerent and even hostile. Patience is a must when handling their ambivalence or outright rejection of treatment. Tenacity to hang in there is also needed, even when one’s limits are tested by irritable rants.

Successful therapists make an empathic commitment to be a faithful companion on a long road to recovery that can be bumpy. For professionals who are invested in caring for their patients, it can be challenging to identify when a situation has progressed beyond business as usual to the realm of threatening.

Third, risk calculations about a patient’s level of dangerousness are complicated. There are no neat algorithms or absolute answers. No blood tests or brain scans that can pinpoint a definitive statistic. Determining risk is as much clinical artistry as it is science.

Finally, there are wider systemic problems at play. Persistent lack of funding for mental health services, loss of invaluable resources such as in-patient psychiatric beds and mental health professionals being increasingly required to do more with less are all factors that pose additional threats to the safety of a work environment.

Along with being competent in how to diagnose and treat mental illness, today’s mental health professional needs to have the stamina and communication skills to continuously advocate for a safe work environment. This is especially necessary when they are caring for patients in large organizations where it’s easy for the voice of frontline clinicians to be drowned out.

ADVERTISEMENT

Twenty years ago, I was a medical student who was drawn to becoming a psychiatrist but put off by the dangerous aura that whorled around this unique medical specialty. I was fortunate to receive the collective wisdom of mentors who did not shy away from this difficult conversation. They also reminded me of what I had to lose by walking away.

The wounds of mental illness manifest in a person’s behaviors which to the untrained eye, can be jarring, bizarre and inexplicable. Yet, we mental health professionals are motivated by the challenge of finding keys to unlock the mysteries of the mind and the reward inherent in helping sufferers heal. Mental illness often cuts to the heart of life, interfering with one’s capacity to love, create, and work. In alleviating the suffering of the mentally ill, we also heal families and communities too. Mental illness is so stigmatized that sufferers face endless barriers when trying to get help. Those we care for are also often marginalized and misunderstood by society. Advocating for this vulnerable population is a worthy way to spend a career.

Today, there are thousands of talented young people who are considering a career in mental health. The tragedy in Yountville may give them reason to consider another path. Even though conversations about the dangers of being a mental health professional are difficult, we must have them.

We all have too much to lose if we don’t.

Shaili Jain is a psychiatrist and can be reached at her self-titled site, Shaili Jain, MD, and on Twitter @shailijainmd. She blogs at The Aftermath of Trauma on Psychology Today, where this article originally appeared on March 19th, 2018.

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government.

Image credit: Shutterstock.com

Prev

Push back on toxic behaviors from other doctors

April 13, 2018 Kevin 63
…
Next

Heal thyself before others

April 13, 2018 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Push back on toxic behaviors from other doctors
Next Post >
Heal thyself before others

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Shaili Jain, MD

  • Treating depression with ketamine: We need incremental treatment for depression

    Shaili Jain, MD
  • What #MeToo must learn from the science of sexual harassment

    Shaili Jain, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Integrating psychiatric care into primary care: The VA example

    Shaili Jain, MD

Related Posts

  • Doctor, how are you, really?

    Deborah Courtney
  • Osler and the doctor-patient relationship

    Leonard Wang
  • Finding a new doctor is like dating

    R. Lynn Barnett
  • Be a human first and a doctor second

    Sarah Murad
  • Drug advertising has helped created victim politics

    Martha Rosenberg
  • Becoming a doctor is the epitome of delayed gratification

    Natasha Abadilla

More in Physician

  • The dreaded question: Do you have boys or girls?

    Pamela Adelstein, MD
  • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

    Muhamad Aly Rifai, MD
  • How grief transformed a psychiatrist’s approach to patient care

    Devina Maya Wadhwa, MD
  • Fear of other people’s opinions nearly killed me. Here’s what freed me.

    Jillian Rigert, MD, DMD
  • What independent and locum tenens doctors need to know about fair market value

    Dennis Hursh, Esq
  • How one simple breakfast question can transform patient care

    Dr. Damane Zehra
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • How the CDC’s opioid rules created a crisis for chronic pain patients

      Charles LeBaron, MD | Conditions
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why the words doctors use matter more than they think

      Erin Paterson | Conditions
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • How the CDC’s opioid rules created a crisis for chronic pain patients

      Charles LeBaron, MD | Conditions
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
  • Recent Posts

    • Rethinking patient payments: Why billing is the new frontline of patient care [PODCAST]

      The Podcast by KevinMD | Podcast
    • The dreaded question: Do you have boys or girls?

      Pamela Adelstein, MD | Physician
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

When the doctor becomes the victim
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...