ER threats aren’t rare anymore

I read Dr. Harry Severance’s recent piece, “Violence in health care: Why doctors and nurses are leaving,” with a sinking feeling of recognition. He’s right. Health care is becoming the most dangerous profession in America. Violence is no longer rare or shocking—it’s something every physician and nurse now half-expects at some point in their career.

I still remember an early shift in the ER when I was stitching up a patient’s forehead and he growled at me, “If you leave a scar, I’ll kill you.”

He said it like he meant it.

Even decades ago, there was a simmering threat under the surface.

What’s changed now is how often those threats are carried out—and how much more unpredictable it has all become.

But here’s the harder truth: While we desperately need systemic reform, most of us can’t afford to wait for it. We still have to walk into those exam rooms tomorrow. We still have to care for patients—some frightened, some angry, some dangerously volatile. And we still deserve to go home in one piece.

So while the bigger battles for health care reform are being fought (and they should be), we need tools. Not slogans. Not empty reassurance. Real, portable, day-to-day tools that can help keep us safe, sane, and still able to do the work we trained for.

Here’s what I teach doctors and nurses who face these realities every day:

1. Learn to read the weather before the storm breaks.

Violence rarely comes out of nowhere. Most of the time, there are signals. Raised voices. Clenched fists. Refusal to follow instructions. Rapid pacing. Personal insults. A gut feeling of “this isn’t right.”

The earlier you recognize agitation, the more options you have to de-escalate—or to leave safely before things escalate.

In every clinic, ER, or hospital ward you work, orient yourself like you would in a new city.

Where are the exits?

Where is security?

What’s your escape route if you need it?

It’s not paranoia. It’s survival.

2. De-escalate with calm, clarity, and respect.

When emotions are running high, your job isn’t to “win” the conversation. It’s to slow it down. To make the temperature drop.

Some basics:

Lower your voice. Speak slower, quieter. It’s almost impossible for someone to shout at a whisper.
Use their name. It re-humanizes the exchange.
Offer small choices. (“Would you like to sit here or over there?”) This restores a feeling of control without handing over the room.
Validate feelings without agreeing to demands. (“I can see you’re really frustrated. Let’s find a way to get through this safely.”)

You’re not agreeing that their demand is reasonable. You’re just recognizing the feeling underneath it. That often diffuses some of the heat.

3. Stay grounded in yourself.

Here’s the part no one warns you about: Your own fear, anger, or frustration can escalate things without you realizing it.

If your body tenses, your voice sharpens, or your words get defensive, you’re feeding the fire.

One practical move: Breathe low and slow.

Let your shoulders drop.

Plant your feet firmly on the ground.

Speak from the chest, not the throat.

You are the calming presence in the room—or you are the gasoline. In a crisis, you only get one choice.

4. Know when to set limits and call for backup.

You are not a hostage negotiator.

You are not a bouncer.

And you are not required to “power through” if you are unsafe.

If a patient or family member is making threats, refusing to back down, or invading your space, call for help early.

Don’t wait until you’re scared. Call security. Pull the panic button. Remove yourself from the room.

One technique that helps: the broken record.

Calmly repeat the boundary, word for word, without raising your voice.

“I need you to sit down so we can help you.”

It’s boring. It’s repetitive. It works better than arguing.

5. Don’t pretend it didn’t happen.

After a violent or near-violent encounter, your body and mind will keep score even if you try to shrug it off.

Take ten minutes—alone, with a trusted colleague, or with a support service if available.

Name what happened out loud.

Allow yourself to recognize the fear, anger, sadness, or helplessness that it stirred up.

This isn’t weakness.

This is basic psychological first aid.

Ignoring trauma doesn’t make it disappear. It makes it harder to stay human the next time you walk into a room.

Final thought

As Dr. Severance rightly points out, the dangers facing health care workers are growing faster than the system is adapting.

We need urgent systemic reform.

But while we fight for that change—and we must fight—we can also arm ourselves with practical skills that help us survive today.

Skills that could make the difference between escalating a crisis and defusing it.

Skills that could save a life.

I heard the threat thirty years ago in the ER.

I hear it louder now.

Patrick Hudson is a retired surgeon, psychotherapist, and author. Trained at Westminster Hospital Medical School in London, he practiced for decades in both the U.K. and the U.S. before turning his focus from surgical procedures to emotional repair—supporting physicians in navigating the hidden costs of their work and the quiet ways medicine reshapes identity. Patrick holds advanced degrees in counseling, liberal arts, and health care ethics, and is board certified in both surgery and coaching.

Through his national coaching practice, CoachingforPhysicians.com, he works with clinicians seeking clarity, renewal, and deeper connection in their professional lives. He also writes under CFP Press, a small imprint he founded for reflective writing in medicine.

His latest book, Ten Things I Wish I Had Known When I Started Medical School, was released in 2025 and became a #1 New Release in Medical Education & Training. To view his full catalog, visit his Amazon author page.