Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Most encounters with patients are conflict-free. That’s the good news. But not all patient interactions are conflict-free. Some can be deadly. Doctors need to understand how to prevent violence in the medical practice – and what must be done when violence cannot be avoided. Here’s a question we field on a near-weekly basis… 

“I’ve got this patient that I’m worried about. They may come to the office and make a scene. They may bring a weapon. But I don’t know how serious they are – or when they’ll show up. But I AM worried. What should I do?”  

This article broadly covers the questions doctors need to ask when evaluating a security risk – as well as strategies they can use to protect their practice if they believe violence is likely – or imminent.  

What most doctors need is the ability to call a security professional at any time, report the situation, and act on the expert’s advice. Our organization has relationships with many such experts – including a team of former FBI agents. In their previous lives, they also worked as hostage negotiators and police officers. They understand violent people. They have assisted many doctors. They’ve seen it all. Angry patients. Family members who are exploding – metaphorically. Ex-employees who want the practice to know who’s the “real boss.” They understand security at the highest level – from security nuances to crises specific to medical practices. 

Our member doctors can receive a referral – we’ll provide a virtual introduction to get the ball rolling. This will help them solve your problems ASAP. To get started, schedule a free consultation with our executive team. 

With that said, our article continues below… 

Why should doctors think about patient violence BEFORE there’s a problem? 

Conflict is inevitable. In aggregate, every practice, regardless of specialty, will be threatened with violence. This threat may come from a patient or from within the practice itself – perhaps a soon-to-be-former employee. If it is predictable, it is preventable. Therefore, train yourself to predict it and have a plan to prevent it. 

How can doctors prevent violence in the medical practice? 

Develop a good relationship with your local police department.  

Invite your local law enforcement officers to tour your practice. Build relationships with them. Ask them what steps you should take to better protect your practice from violence. We are serious. Most would welcome the chance. The logic is simple. If law enforcement knows the layout of the practice, it becomes easier for them to do their jobs – intervene and de-escalate potential violence. And in a crisis, this knowledge helps them save lives. 

Next, train yourself and your staff to spot potential offenders.  

Devise a formal security plan. Preventative care is almost always less expensive and less bloody than remedial care. Understand as best you can the history of your patients. It isn’t necessary to profile everyone who walks through your door, but if the patient threatens you or your staff, look them up. If they have a history of violence, take those threats seriously. Make your contacts at the police department aware of this individual and his threats. This information will help them help you evaluate the danger posed by this patient. 

Train your employees so that they are “situationally aware” of their surroundings. In short, train them to pay attention to people’s behavior. Empower them to report potential security threats. To take this a step further – listen to your staff. If they believe a patient is a potential security threat, don’t allow yourself to be blindsided by your own bias. A patient may behave themselves around you but mistreat your staff. 

Repetition is powerful. Mention security every time you meet with your staff – even if it is just discussed for 30 seconds.  

The passage of time can ingrain these rules into your brain if you make security a regular discussion. Tell your staff to bring you the good news AND the bad news specific to patient behavior. And train them to present potential solutions when presenting problems. 

Next, recognize the personal challenges that cause patients to become violent. A patient known to have experienced one or more of these challenges should be considered a potential liability.  

History of domestic abuse (this is a BIG red flag)… 

Suicidal ideation (“If you don’t treat me, I’ll kill myself…”) 

Recent job loss… 

Loss of money/substantial debt… 

Recent divorce… 

Addressing employees – what about background checks? 

These are critically important but be careful what kinds of checks you order. All checks are not created equally. Specify you want a complete 50-state criminal and civil background check. Verify education and credentials. Failure to do so can constitute negligence and expose you to significant risk.

Make sure prospective hires tell the truth; for example, confirm they have not placed falsehoods on their resumes. You cannot lie in a healthcare setting. A hire who lies on his resume may lie to you or a patient if it means avoiding a conflict – and this can be deadly… 

A violent patient has been dismissed from the practice – and you just got a phone call: “I’m on my way NOW.” You believe the patient will create violence. What next? 

Call 911. If you believe a violent individual is on the way to the practice, call the police immediately. Your instinct might be to delay this call and wait it out – you may be worried the presence of police will inflame the patient further or that the police will not perceive your problem as a genuine “problem.” You don’t want to be perceived as “the doctor who cried wolf.”  Silence this inner voice. 

Your goal is to stop conflict. The presence of police makes most irrational patients rational. Most will step down if they know their ultimate reward is a pair of handcuffs and an assault charge.  

Addressing violent, armed patient conflicts within the medical practice – should doctors/nurses carry concealed weapons in the medical practice? 

You must be prepared to address the liability if you choose to draw your weapon. Just because you have a weapon and are licensed to use it doesn’t guarantee you’ll hit your target. In a crowded practice, you may hit an innocent bystander. These are scenarios you must consider. You must understand the law and the risks. And you must train.  

If you do choose to carry in the medical practice, in addition to all the above, you must carry substantially more liability insurance than your unarmed peers. You’ll need it in the event of a tragic outcome – i.e., a weapon you fire strikes a bystander by mistake. 

Consider the following real-world vignette, shared with us by the FBI agents we mentioned earlier in the article.  

A pharmacist was taking care of his customers. He was approached by two burglars – both armed. The burglars demanded money and drugs. The pharmacist drew his concealed weapon in self-defense. One burglar was injured. The other was killed – the only fatality. Neither the pharmacist nor his customers were injured. In their opinion, the pharmacist’s actions saved lives.  

But the pharmacist was not an amateur. He was HIGHLY trained in the use of his concealed weapon. And because he was highly trained, he could assume total responsibility for the use of that weapon. 

Here are the basics… 

If an individual decides to carry a firearm, the firearm must be legal…  

The carrier must be licensed to carry that firearm in the state/county of residence where they are practicing/working… 

The carrier must have adequate training and displayed proficiency in using the weapon – and their ability to use the weapon proficiently must be certified and documented… 

A hard reality many overlook: Even trained professionals can miss their target. And the trajectory of a bullet that misses its intended target (or even strikes its intended target) is unpredictable. 

It is said: “Those who live in glass houses should not throw stones.”  

It should also be said: “Doctors who work in practices made of sheetrock should not carelessly discharge a concealed weapon.”  

Does it roll off the tongue? No. But you get the point.  

A doctor is afraid a patient will become violent if the patient is told not to return to the practice. Should that doctor consider hiring a security guard?  

Most hired guards are there to deter violence, not intervene. Meaning they won’t engage a violent patient or intruder on your behalf. But sometimes their presence is enough to make people behave rationally. In the event you hire a guard, you can specify whether the guard appears in uniform or in plain clothes. Doctors need to consider the pros and cons. A uniformed guard will serve as a stronger deterrent – but his presence will likely make patients feel uncomfortable. They’ll ask questions.  

“Why is there an armed security guard in the practice?” 

“What is going on that I don’t know about?” 

“Am I safe?” 

A plainclothes guard will be less obvious, and therefore likely less of a deterrent – but most patients won’t even know the guard is present on account of his camouflage.  

Hiring off-duty police officers is the better strategy, as they are trained to interdict in the event of a violent conflict. These individuals are licensed, bonded, and trained.  

And if you have an imminent threat, call 911 – not a security guard.  

If you are serious about neutralizing the threat of violence, you must consult with the experts. Our organization has relationships with many such experts – including a team of former FBI agents. In their previous lives, they worked as hostage negotiators. They know violent people. They have assisted many doctors. They’ve seen it all. Angry patients. Family members who are exploding – metaphorically. Employees who want the practice to know who’s the “real boss.” They understand security at the highest level – including security nuances to crises specific to medical practices. Most patient interactions are conflict-free – but not all. Some can be deadly. Preparation is key. 

Doctors who join our organization can receive a referral – we’ll provide a virtual introduction to get the ball rolling. This will help them solve your problems ASAP. To get started, schedule a free consultation with our executive team.

Learn how Medical Justice can protect you from medico-legal mayhem… 

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2021 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.