It’s the last place where violence should prevail. Doctors and their patients come to physician private practices seeking opportunities for healing and better health all delivered in a safe environment. And most of the time, that’s what they get.

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But a growing environment of social discord and violence touches everyone—even physicians—and physicians need to be prepared o deliver safety in their offices as well as medical advice, according to AMA member Carolynn Francavilla Brown, MD.

Carolyn Francavilla Brown, MD
Carolyn Francavilla Brown, MD

Dr. Francavilla Brown is a family physician and obesity specialist serving as chair-elect of the AMA Private Practice Physicians Section Governing Council for the 2022–2024 term. She owns and runs a four-physician family practice called Green Mountain Partners for Health in the Denver area.

She discussed the topic of workplace safety during an education session at the 2022 AMA Interim Meeting in Honolulu as a joint program among several AMA groups and sections.

“Workplace violence has always been at the heart of my practice,” she said, noting that several of the initial staff at the clinic had personal experiences with workplace violence prior to starting work there.

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Workplace violence also has affected her and her staff personally, with Dr. Francavilla Brown getting “a death threat from a patient who had been hospitalized in psychiatric care.”

The patient, who she saw in a facility outside her office, was seeking more psychiatric care, Dr. Francavilla Brown explained, “and the way he went about getting that was to threaten” her. In response, Dr. Francavilla Brown contacted police to alert them to the situation and ask for additional patrols in the area of the facility. She also alerted staff to the threat, giving them the option of not coming to work until the threat was resolved.

Dr. Francavilla Brown also examined the security of her practice office, locking the main entrance that previously was kept open and alerting staff to a second entrance and exit that was not commonly used.

Shortly after this experience, she said the office received another threat from a patient who was unhappy with the types of medication he was prescribed. The treating physician got a restraining order and terminated care for that patient.

It is true that physicians have a responsibility to provide care to their patients, Dr. Francavilla Brown said, but that responsibility is not overriding.

“Your safety is paramount,” she said.

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How can a small private physician practice improve their safety without the resources of a hospital system or large facility? First, acknowledge the possibility. “What would we do if there was a threat?”

Also, she recommended a review of the resources that are already present. Does the office space have a security guard? Can the doors be locked to permit access only to properly identified visitors? Does the space have security cameras, or can they be installed easily and quickly?

A private practice can also provide chaperones in some circumstances. Usually, chaperones are provided for patient safety and security, but they can also provide security for physicians, she said.

Training is also important. Not only should staff be prepared to identify intruders and call 911, if necessary, but special training could be useful. Local security services can provide active-shooter training, for example.

“The biggest thing you can do in a small practice is recognizing the needs and having a culture of safety,” she said, and alert patients and staff to boundaries that support safety. Physicians and their private practices are not obliged to treat people who are making them feel unsafe or uncomfortable.

“You are not an emergency room,” Dr. Francavilla Brown said, “so if there is someone making your job unsafe, you can terminate that relationship.”

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