Have you ever felt threatened by a patient?

Urology Times reached out to three urologists (selected randomly) and asked them each the following question: Have you ever felt threatened by a patient?

Dr. Babayan“Incidents have been few and far between, but yes, it’s happened. I’ve been in practice almost 40 years, so of course it’s happened. It’s been a while, so it’s hard for me to remember details-there was never anything life-threatening.

There’s not one inciting factor. I think a lot of it is misunderstanding or miscomprehensions. It was more verbal abuse-people with anger management issues. I did call security on one or two occasions. Usually you can talk a patient down. You sit them down and show them their record. If you show them that you did explain their situation to them, things are likely to resolve.

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There may have been a complication they weren’t happy about. For instance, with transurethral resection of the prostate, I warn everybody they are going to get retrograde ejaculation. Sometimes these guys come in and say ‘Why didn’t you tell me this?!’ I point out in my notes that it was discussed, and I have handouts that I give them that clearly state retrograde ejaculation. I point that out, they say, ‘Oh! I never read that.’ So, it’s mostly miscommunication.

There are probably one or two instances in the past that I might’ve felt physically in danger, but nothing recently. I work in a safety-net hospital with a lot of underserved patients who aren’t always the most informed, so it’s mostly misunderstanding. My philosophy has always been, if you’re kind and compassionate to patients, they respond likewise.”

Richard Babayan, MD

Boston

Next: "Things have gotten worse. Patients are definitely more demanding."

Dr. McCullough“Yes. There have been several instances. I had one patient about 9 years ago who came in for a BPH check for obstructive symptoms. I asked him to pull his pants down to do a prostate exam and he took out a gun and set it on the table next to me. I had no idea he was carrying a gun. I didn’t say anything. I just did the exam and he went on his way, but that definitely made me feel uncomfortable in the situation.

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We’ve had other patients who have just been argumentative or confrontational who are mentally unstable. Often, it’s drug-seeking behavior.

One man who’d been treated for years for bladder cancer with TURBT and BCG and mitomycin. He was convinced he had pain was from bladder cancer, even though he clinically had no evidence of disease. He wanted painkillers, which he didn’t need. He was adamant. I told him that’s not what we do here; we took care of your bladder cancer and you’re cancer free. There’s no urologic cause of pain. I offered to refer him to a pain specialist, but he was already seeing one. ‘Those guys don’t understand; they don’t want to give me my medicine,’ he said. That’s when he became threatening and said he would come back and take care of us. ‘I have guns.’ We decided to call the cops. He left on his own, but we called police and they found guns in his house. Because of that threat, which he made in several offices, he was banned from ever coming back on the hospital grounds again.

It made us more aware of security. Now the door to come into the clinic can only be opened from the inside, as opposed to leaving it unlocked.

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Things have gotten worse. Patients are definitely more demanding. They want to be treated like gold, and there’s such a shortage of physicians that we can’t see everyone as fast as we’d like or spend as much time as we would like with everyone. Then we have these episodes where there’s high tension. Sometimes unfortunately, it’s not a good outcome.”

Casey McCullough, DO

Norwich, CT

Next: "A patient was violating an office policy and I called him out on it and he got angry."

Dr. Nakada“I haven’t felt threatened in a long time. I’ve been in practice 22 years and it has happened maybe once.

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A patient was violating an office policy and I called him out on it and he got angry. We had a no-smoking policy in our office-now everybody does-but this was way back in the ‘90s and the patient was smoking in the patient room. I told him he couldn’t do that. He got very angry and I almost called security. I told him he couldn’t smoke there and he said he didn’t. I said, ‘Ahhh, the room is smoky, so obviously somebody was smoking in here. Don’t do it.’ He got very angry and said, ‘I wouldn’t do that.’ I said, ‘Do I need to call security or can we continue?’ He said, ‘Let’s continue.’

But that was the only time anything like that ever happened and I felt uncomfortable.”

Stephen Y. Nakada, MD

Madison, WI

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