title: What variables are associated with an expressed wish to kill a doctor in community and injured patient samples?
abstract: Working in a health care setting has been identified as a primary risk factor for violent assault, which is often perpetrated by patients. Patient dangerousness is a multidimensional phenomenon, which may include violent ideation, homicidal planning, a history of violent acts, or overt threatening behavior. Although the verbal report of thoughts of killing a doctor is only one of many risk factors for patient dangerousness, reports of homicidal ideation are widely regarded as being sufficient to warrant concern, and to indicate a need for further assessment of the patient. In this study, 2264 subjects (1329 healthy community subjects, 158 non-healthy community subjects, and 777 rehabilitation patients) were asked if they had a desire to kill a doctor that they had seen. Subjects responding positively to this item were compared to subjects responding negatively to the item using all available demographic variables and BHI 2 scales using chi-square or t-test. Significant variables (p<.01) were then utilized in a logistic regression to generate a model for this wish. Three variables significantly predicted this wish: the Doctor Dissatisfaction (p<.001) and Borderline (p<.001) scales of the BHI 2, and injury-related litigation status (p=.002). The presence of one of these variables, especially Doctor Dissatisfaction, should prompt a more thorough assessment of potential danger to healthcare workers.
authors.affiliation: Health Psychology Associates, 1610 29th Avenue Place, Suite 200, Greeley, CO 80634, USA. dbruns@healthpsych.com
authors.forename: Daniel
authors.initials: D
authors.lastname: Bruns
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: John Mark
authors.initials: JM
authors.lastname: Disorbio
authors.forename: John E
authors.initials: JE
authors.lastname: Lewis
mesh_terms: D000328:Adult; D003153:Community Health Services; D003617:Dangerous Behavior; D005260:Female; D006708:Homicide / Q000523:psychology*; D006791:Hostility; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D008297:Male; D008318:Malpractice; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology* / Q000534:rehabilitation; D008875:Middle Aged; D009042:Motivation; D010146:Pain / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation; D017060:Patient Satisfaction; D010555:Personality Inventory / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011594:Psychometrics / Q000706:statistics & numerical data; D012044:Regression Analysis; D015203:Reproducibility of Results; D012803:Sick Role; D012907:Smoking / Q000453:epidemiology; D014481:United States; D014754:Violence / Q000523:psychology*; D014947:Wounds and Injuries / Q000175:diagnosis / Q000523:psychology* / Q000534:rehabilitation