‘So much to say, yet no words will ever be enough.” Vicki Pettersson
My heart is broken. It was difficult to sleep last night. Earlier this week, an Alberta family physician, Dr Walter Reynolds, was killed in a targeted attack at his Red Deer clinic. I feel paralyzed, as there is no action that I can take to mitigate the sorrow at the senseless loss of a husband, father, and devoted physician.
As we await more details of the circumstances surrounding the crime, I am certain that many of us are recalling and in some cases, reliving our own past encounters with violence. We work on the frontline, often with a skeleton crew. Often, we work late at night, or overnight. There are times, when few people are around, that we know we are at risk. In these settings, we meet face-to- face with patients at their most vulnerable. We never know with certainty what we will face, particularly with patients we have not encountered or treated before.
In training, we had the opportunity to practice various potential clinical encounters as we were preparing for our clinical assessments. I distinctly recall a scenario where the behaviour of the “patient” - a volunteer clinician- escalated to yelling. They could not be settled, and suddenly burst out of the room. I asked the examiner if I was expected to go after the “patient”, as this was not my intention. I was reassured that this was not the expectation. I had no idea what lay ahead in my career, and this experience served as little preparation.
For myself, I truly awoke to the reality of my risk when a known patient brought a relative of theirs, who was clearly in distress, to my office at the end of the clinic day. The patient was behaving strangely, and the family was worried. I stepped into my small, sparsely furnished, windowless exam room at the end of the hall. The patient was agitated and pacing.
I proceeded to sit down on my stool at the foot of the exam table to give him more room to pace. It was only then that the patient looked up. The expression was unlike anything I had seen in my career to date, or since. His eyes appeared wholly black, endlessly deep and yet keenly focused on mine. For the first time in a patient encounter, I felt afraid for my personal safety.
This patient was cooperative, and responded to my queries with an uncanny, measured calmness. “Yes, I am restless. I cannot stop the thoughts in my head that I need to kill my family. I just need to hurt someone.” Only then did I understand. At that point, I was aware that the patient was standing between me and the only exit in the room. There were no defensive action options for me to take. While I did extricate myself from the room safely, and the patient did receive the necessary help, it emphasized my vulnerability. I have tried to never repeat that same mistake. I find myself surveying my surroundings to ensure my safety before closing the exam room door. I try to ensure I understand the behaviour of patients prior to them being placed in the exam room.
A rural physician recently shared the story of an encounter where they were assaulted by an emergency room patient, treated the same patient, and then had to suture their own lip - before returning to finish their shift. This should not happen to anyone, ever. I recognize that many necessary safety measures may well be difficult to implement in all examination settings across BC, but we must begin to take steps to ensure the physical safety of our physicians.
A Canadian survey highlighted that among 720 primary care physicians in the country, 30% had encountered aggressive behaviour in the month prior and, of those, 39% stated that the behaviour was severe in nature, i.e. assault, stalking, or sexual assault.
In response to the growing reports of violence towards physicians, Doctors of BC published a Violence Prevention Guide for Community Practices in September 2019. The guide outlines tangible steps and links to resources that can support the safety of frontline community-based physicians and their staff.
In addition, Doctors of BC is working with our provincial Health Authorities BC to address physician physical and psychological safety in our facility-based workplaces. I encourage you to reach out to your local Regional Advisor and Advocate if you are currently experiencing an unsafe workplace. I urge everyone, including facility-based physicians, to read the above guide and review their practices. Do not delay.
Physicians work is by nature hands-on, one-to-one, and pre-COVID, primarily in person. We will never be completely safe from harm, as the recent tragedy has so terribly emphasized. What we can do, is have open discussions about our risk and practices to mitigate that risk. Our lives depend on these crucial steps. Each of us is valuable and precious, and we simply cannot afford to take chances that lead to another physician’s life being cruelly cut short.