How to Prepare for and Survive a Violent Patient Encounter


When the unthinkable happens, having a plan that you have practiced regularly can make all the difference.

Fam Pract Manag. 2018 Nov-Dec;25(6):5-10.

Author disclosure: no relevant financial affiliations disclosed.

Related article from American Family Physician: “Violence in the Health Care Setting: What Can We Do?

On Jan. 28, 2013, Stanwood Elkus arrived for a doctor's appointment at the Newport Beach, Calif., office of urologist Ronald Gilbert, MD. This was the second time in a week that Elkus had attempted to see Dr. Gilbert. Previously, after staff members had prevented Elkus from entering the back office area as a “walk-in” patient, he had agreed to make an appointment, which he did using a false name and telephone number.

Elkus blamed Dr. Gilbert for a surgical procedure he had undergone 25 years earlier that had damaged his prostate and led to complications. Two other physicians actually performed the procedure, but Dr. Gilbert, then a young resident at a local Veterans Administration hospital, had recommended the procedure to Elkus.

On that January day, after Elkus filled out his new patient paperwork in the waiting room, office staff took his vitals and escorted him to an exam room. Shortly after, Dr. Gilbert entered the room and introduced himself to Elkus. The patient then shot the physician 10 times in the chest and neck, killing him.1

For several hours following the shooting, my nearby office was on lockdown and ordered to “shelter in place,” during which we kept our staff members and patients safe inside. Other offices, however, did not seem to understand the shelter in place order or follow other safety training, and we saw physicians, staff members, and patients moving in the direction of the shooting. The shooter in this case surrendered immediately, but the outcome could have been very different had the assault continued.


  • Workplace violence is most common in the medical setting, and it frequently involves a patient or family members threatening physicians or practice staff.

  • Physicians and staff should receive training on spotting potentially violent behavior and defusing these situations before they escalate.

  • Practices should develop detailed plans for dealing with violent incidents, including how and when to escape, how to protect patients, and how to cooperate with law enforcement.

  • If a violent incident is inescapable, physicians and staff must be ready to fight back with whatever resources they have available.


One of the most difficult situations a physician will face in his or her career is being threatened with physical harm, most commonly by a patient or family members of a patient.2 Violence in the medical setting is sadly not unheard of; according to the U.S. Bureau of Labor Statistics, more than 70 percent of all workplace assaults occur in the health care and social services industry.3 Reasons for this include feelings that health care services have become more impersonal, longer wait times, unmet patient expectations, increased patient agitation,


Dr. Cheng is a family physician with PersonalCare Physicians of Newport Beach, Calif. He also serves as an instructor for active shooter training and disaster preparedness as well as a reserve deputy sheriff with the Orange County Sheriff's Department, where he is a team operator and tactical physician on the department's SWAT team.

Author disclosure: no relevant financial affiliations disclosed.

Editor's note: See the related article “Violence in the Health Care Setting: What Can We Do?American Family Physician, Sept. 15, 2018.



show all references

1. Puente K. Jury convicts man of first-degree murder for killing Newport Beach doctor. Orange County Register. Aug. 21, 2017....

2. Kowalenko T, Walters BL, Khare RK, Compton S. Michigan College of Emergency Workplace Violence Task Force. Workplace violence: a survey of emergency physicians in the state of Michigan. Ann Emerg Med. 2005;46(2):142–147.

3. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. Washington, DC: Occupational Safety and Health Administration; 2015.

4. Joint Commission. Physical and verbal violence against health care workers. Sentinel Event Alert. 2018;591–9 Accessed Sept. 19, 2018.

5. Blair JP, Martaindale MH, Nichols T. Active shooter events from 2000–2012. FBI Law Enforcement Bulletin. Jan. 7, 2014. Accessed Sept. 18, 2018.

6. Inaba K, Eastman AL, Jacobs LM, Mattox KL. Active-shooter response at a health care facility. N Engl J Med. 2018;379(6):583–586.


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