Our risky business (Australian Doctor 3 Dec 2010)

December 3, 2010 § Leave a comment

WORK can be a health hazard. Theodore Rothonis, a Sydney GP, would attest to that. The patient who stabbed him has just been tried (he was found not guilty on mental health grounds but will be detained in a prison hospital until authorities deem he no longer poses a risk to the public).

Recent tragedies confirm that working in mines is also dangerous. So is clearing mines, when it is done by peasants or Hurt Locker GIs rather than Princess Di. The most dangerous jobs, however, are illegal. Street prostitutes and drug dealers often meet untimely ends. General practice has its hazards but there are more GP suicides than murders.

A colleague recently asked if I would accept another patient. The man had disclosed a fantasy that involved slicing his doctor’s flesh with a carving knife. Last Tuesday, I met my new patient and he was as nice as pie. A forced stint in hospital and the knowledge that you’re running out of treating doctors can improve attitude problems.

On Wednesday, I visited a hostel. One resident has a stream of interesting ideas. His latest is to get bullet-shaped mouldings clamped onto cars so they can be shot through tunnels under cities.

Even by my jaded standards, when I saw him this week he seemed dangerously agitated. I suddenly understood why he gets weekly ECT. I left as the uniformed cavalry arrived to get him to hospital.

Workplaces often have duress alarms but I have never used one. Anyway, I suspect blood-curdling screams are more effective.

I was once attacked by a patient when an alarm was within reach. I was too busy to consider activating it. I lost a shirt button when without warning an intellectually impaired man grabbed my neck. His carers later commented that his mother regards him as “80% intellectually disabled and 20% evil”.

At an Aboriginal medical service, I once discovered a large kitchen knife stashed among the paperwork. The nurse explained that it was for her protection. The knife did not make me feel safer but each to their own. I did not want her job.

Seventeen years in a clinic for homeless youth provides a few more anecdotes. For instance, I have twice wrestled bloodied broken glass from patients who were busily gouging their forearms in front of me. I guess this seemed less hassle than suturing them up.

I have also had a pistol waved at me followed by the explanation that it was only a replica. On another occasion, a patient suddenly lunged towards my abdomen with a kitchen knife. I jumped back, which prompted an exasperated, “Jesus Doc, as if I’d stab you! I’ve known you for ages!”

A couple of years ago, I found myself physically intervening in a fight. One of my patients was on the ground being kicked in the head.

I rang Medicare that night. I figured my actions had saved the health system a pile of cash so I asked about an item number for prevention of acquired brain injuries.

I waited in nervous anticipation and could hear the Medicare woman banging her keyboard in the background. Her answer? “The computer says no.”

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