When a Difficult Patient is a Violent Patient

Remember that" Seinfeld" episode where Elaine can’t get any doctors to see her because her last doctor wrote in her chart that she was "difficult"? Can that happen in real life? Can physicians refuse to see patients they have never seen before because the patient has a bad reputation?

I’m not talking about true medical emergencies; and I’m not talking about patients who are merely annoying or non-compliant. I often have referring physicians "warn" me or apologize in advance that they are sending me someone who (nicely put) is "a character" or is "a problem patient." I certainly don’t refuse to see those patients. And I often find that "non-compliance" is often due to not understanding the consequences of their decisions or the importance of adhering to the medical plan.

I am talking about patients who may be a danger to me, my staff, and my other patients. Case in point, I was recently asked to see a patient in the hospital. Before I walked into his room, I looked at his old records and saw that he had been seen previously by a different practice. Realizing that sometimes referring physicians don’t know that the patient has an endocrinologist already, and not wanting to usurp somebody else’s patient, I walked in, introduced myself and asked the patient if he already sees Dr. X. He started to say yes then his nurse dragged me out of the room.

She told me that the patient was brought to the hospital from Dr. X’s office, after he had allegedly assaulted a staff member and broke several windows in the office. Needless to say, Dr. X wasn’t coming to see him in the hospital. So in the presence of a security guard and the comfort of knowing that the patient had already received meds to keep him nice and calm, I saw him. He has a known psychiatric disorder and is receiving inpatient treatment now.

So my question is: Once this patient is discharged, assuming he doesn’t land in jail, what do I do if he wants to follow up in our office? I’m not going to lie to you; I’m afraid of him. He is a big scary guy. He seriously injured Dr. X’s staff member. He allegedly threw a rock at a police car. I don’t want to be alone with him in a room. We are five women in our office. The other office had two men and couldn’t stop the destruction (you should see their office!). I don’t want to put my staff and other patients in danger. Can I refuse to see him? What are the legal repercussions of that?

How else can I keep everyone safe if we do see him? Do we require that he come with someone? He had gone to the other office with his mother. Do I keep the exam room open? What about his privacy? Oh, sure, I can keep mace in the office, but by the time you realize you need the mace, you’ve already been punched in the face!

On the other hand, is this man, who has a mental disorder, condemned to a life without proper medical care? He has medical issues as well and will need to follow up somewhere.

I have very mixed feeling about this. I am concerned about my own personal safety and that of my staff and patients. I feel compassionate towards this man who has a mental illness. I am worried about the legal consequences of refusing to see him. I am concerned about the financial consequences of having the office damaged by him.

We have had angry patients. A few of whom I had fleeting concerns about them doing something violent. We also have patients with mental illness, but I have never worried about them hurting anybody. We have in place an emergency plan in case of violence. One staff member is to evacuate the patients, the other to ensure all staff members evacuate as well, and someone is assigned to call 911.

I would much prefer to not have to use our emergency plan.