When you go to work do you expect to be hit? When you walk out of the office, do you expect to be spat at? When you go to the car park do you expect to have a note stating someone will kill you?
I apologise to start this article with such force, however this is my life. I became a doctor with the plain intention of saving a life. It sounds cliché, I admit, but one does not sacrifice their life for one with constant examinations into their thirties, missing your own birthdays as well as important family events, doing 84 hours a week, for their own fun as a doctor. It is with the primary aim of wanting to help people.
I had intended to be a surgeon, I admit it. I enjoyed getting my hands technical with grasping the stitch in a beautiful pattern, to solve a problem then and there, the fast pace, the adrenaline, the actual life in your hands. It was an intoxicating feeling. Then, for one fleeting week, I was exposed to psychiatry whilst being a junior doctor. I had a poor experience in medical school of psychiatry and never got to grips with what it was. I was clueless. If I’m honest, which I always am, you also see the world of medical specialities in a different light once you actually become a doctor. How you view specialities as a medical student is far different to actually working within it as the doctor. In my fleeting week, I was one of the doctors in the psychiatry department. It felt like I had met my soul mate. The instant attraction. Psychiatry was my partner. From that week, I changed my career route to psychiatry and I have never looked back. Gone are the days of bright theatre lights, the rubber gloves suited and booted for surgery, the blood, the organs, and the sutures. I entered through the doors to the Mind, the ocean of personalities, the psychodynamic rays of light, and found my new forefather: Freud.
But with this magical land of neologisms, I came across a demon. That demon was staff abuse. Psychiatry does deal with a mix of patients, and usually in hospital you face the most psychotic patients at their worst. When in such a state, there can be an increased risk of aggression and hostility towards the forefront staff. There is also a sub speciality of forensic psychiatry, in which you have patients with mental health from a background of some sort of forensic involvement, either directly from prison or with a past history of such. There are rapists, there are paedophiles, and there are psychopaths. I as a doctor cannot choose whom I want to treat. We see the extreme, and treat the extreme. But this comes with risk, and the risk is normally to us as staff.
A psychiatrist has a lifetime risk of being stalked by a patient/or a relative of a patient up to 20%. I have seen staff assaulted, threatened, abused by their patients, and in the sad reality there can be deaths. I am not saying that all patients are at high risk of harm to their staff like this, but that does not mean there are not any statistics of staff not being harmed. I never thought I would have to look at my personal safety when coming to work, but I do. It’s a reality for all of us psychiatric staff. I have been threatened myself and been very nearly attacked by my patients. I have had to make police reports, and take strategies to make sure that I am as a safe as possible. I have had to change my social media so that patients are less likely able to stalk me, and no longer take my car to work as colleagues have had threatening notes left on their cars. I would be lying if I said at times I am not scared of my profession. I have had times when I have not been able to sleep for replaying a near miss incident of a patient trying to attack me earlier that day. I’m not a ninja. I am a doctor to heal. I have had friends say: “well what do you expect, you chose mental health?” That is a stigmatised comment, I know, but the fear is there, and it’s prominent. I commend all the staff, especially the nursing staff for the risks they face at work. I love my job, and I still don’t think I would chose to be another kind of doctor other than a psychiatrist.
I have taken an oath to respect my patients no matter who they are and treat them with the best care I possibly can. However, that does not mean I should fear for my life.