Hopkins Incident Highlights Patient-Physician Interactions

The shooting of a doctor at Johns Hopkins Hospital in Baltimore yesterday reminds us of the intricacies of physician-patient interactions, especially when difficult news is delivered.

To recap - not that the Baltimore Sun did not do a superb job in their coverage -a Virginia man, very upset at the condition of his elderly mother following her cancer surgery, shot and wounded an orthopedic surgeon in his mother's hospital room. The physician is expected to recover, but sometime during a three-plus hour standoff with police, the man fatally shot himself and his ailing mother.

Some say the hospital should have taken greater steps regarding security, but that is another issue. The greater issue here is the emotional distress indicated by the gunman. The Sun reports that he blamed the doctor for paralyzing his mother during surgery, allegedly telling the surgeon, "you ruined my mother." A nurse told the Sun that the complications from surgery were not the doctor's fault.

Another report indicates that when the doctor tried to console the man by putting his arm around him, and that is when he was shot in the abdomen.

There was recently an interesting essay in JAMA on the issue of patient-physician interaction, specifically holding the hand of an upset or tearful patient. The gist of the essay is that these interactions differ physician-by-physician, situation-by-situation and there is no "golden rule" to follow.

We've written about problem patients and dealing with emotional patients before, but as the JAMA essay points out, how to deal with an upset patient is at the physician's discretion. Some believe in hand-holding with a tearful patient, while others find it unprofessional.

Did the Hopkins physician do anything wrong by trying to console an upset family member? In my opinion, no.

Some will argue about "setting boundaries" and that security should have been called to be part of the discussion, while others will agree with what the Hopkins physician did 100 percent and have done the same exact thing numerous times without harm.

Soon, the doctor may share with us what he was thinking at the time of the incident, what he said to the deceased gunman, and what complications the mother experienced. Or, we may never know.

The fact is that this scenario of physicians breaking difficult news to patients happens every day in hospitals and practices everywhere. There are red flags, definitely, but in most cases, a physician never knows at the start of the discussion how it will end. That unpredictability is part of the job.

A few months ago, The Joint Commission - a nonprofit group which certifies healthcare organizations nationwide - noted that data indicates an increase in hospital violence. Most notably, the data indicated increasing events of assault, rape, and homicide in hospitals over the period of 2007-2009.

Mark R. Chassin, MD, The Joint Commission's president, pointed out in a statement that "healthcare facilities should be places of healing, not harm," but "unfortunately, health care settings are not immune from the types of violence that are found in the other areas of our lives."
This was certainly the case at Hopkins yesterday. But it is also the extreme case study of physician-patient interaction.

Perhaps today is a good day to talk with your staff or your colleagues about such interactions, what you do, what you don't do, what your policies are. It is very unfortunate what happened at Hopkins, but rather than point fingers and place blame, let's talk about the issue and find some solutions instead.