tag:blogger.com,1999:blog-7772182113499451603.post7109630898538564572..comments2024-03-27T10:50:53.692-05:00Comments on Real Psychiatry: Why Would A Psychiatrist Carry A Gun?George Dawson, MD, DFAPAhttp://www.blogger.com/profile/03474899831557543486noreply@blogger.comBlogger10125tag:blogger.com,1999:blog-7772182113499451603.post-16901061062677930642015-05-29T02:36:24.479-05:002015-05-29T02:36:24.479-05:00I really appreciate you for taking up this issue o...I really appreciate you for taking up this issue of physcatrist carrying guns, of course they encounter various patient which are dangerous.hem latahttp://airriflecenter.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-32923147031627736132014-08-17T20:13:36.240-05:002014-08-17T20:13:36.240-05:00Posted for guys on the Animal list. In addition t...Posted for guys on the Animal list. In addition to thoughts about a shrink carrying a gun I am interested to hear responses to issues raised in the comment section specifically ways psych techs can deal with violent patients.Dr Kevin Keoughhttps://www.blogger.com/profile/04465104710377799136noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-50663338783182535432014-08-12T12:53:24.066-05:002014-08-12T12:53:24.066-05:00I don't think most residents would really take...I don't think most residents would really take well to learning advanced joint locks etc. However, some basics such as using a chair to defend against a knife attack and the like would be of significant value. Goal is to buy time and avoid injury.<br /><br />https://www.youtube.com/watch?v=2tdBKN9QBVo<br /><br />James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-85431439685492747252014-08-02T13:26:36.769-05:002014-08-02T13:26:36.769-05:00It is good to hear that there is a course like thi...It is good to hear that there is a course like this. The experience in Minnesota is limited to various consultants who present methods that are completely based on verbal interventions or even more incredibly - a course that views patients who have problems with aggression as trauma victims themselves. The latter is an introduction to an approach to limit physical interventions.<br /><br />I certainly think that all possible measures should be taken to de-escalate situations and prevent physical contact at all but it seems to me that an approach to look at the possible childhood origins of aggressive behavior misses the mark. In at least one situation, a local hospital tried to eliminate a ward for men who had problems with aggression and found that was not possible with the new approach. I don't think it has worked in a state hospital system either. In some of these cases the initiatives were done by administrators with no psychiatric expertise. I would like to see a course in residencies that addresses all aspects of violence and violence prevention including how to implement useful programs in hospitals, clinics, and communities. I can guarantee that nobody thinks about that more than psychiatrists who have been exposed to it.<br /><br />On the issue of psychopaths with guns, I think the only time there are problems is in random occurrences that would expose anybody (like a mugging), if they also happen to be psychotic and need psychiatric services, or if they are trying to get psychiatric services for secondary gain like food, shelter, and disability payments. I think that the people with real psychosis and paranoia are probably the ones that present the real problems. There are also some who become infatuated with psychiatrists and homicidal while stalking their psychiatrist.George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-9706281814093155212014-08-02T11:26:15.239-05:002014-08-02T11:26:15.239-05:00At the residency where I teach there's a "...At the residency where I teach there's a "Diffusing Assaultive Behavior" course given to all residents, attendings, and clinical staff, e.g., nurses and techs. If I recall, it's a one-day course with an optional half-day refresher that can be taken later. As the name implies, it's mainly geared to recognize and defuse (and diffuse?) impending aggression, starting with where to position yourself in the room, verbal interventions, and the like, progressing to how to assist in a take-down, apply restraints, etc. There's probably an hour on physical self-defense, getting out of choke holds and the like, but this isn't the emphasis.<br /><br />Obviously, this kind of one-day course won't help much against a psychopath with a gun. Neither will an introduction to Krav Maga, unfortunately. But it does seem more fitting for most potential violence on a psychiatric ward.<br /><br />By the way, the inpatient residents and attendings don't wear ties (except those altered to tear-away in an assault). The gun question is a whole other matter.Steven Reidbord MDhttp://blog.stevenreidbordmd.comnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-70008962661638987642014-08-01T18:40:24.638-05:002014-08-01T18:40:24.638-05:00I wouldn't count on administration to do anyth...I wouldn't count on administration to do anything except be passive aggressive Monday morning QBs. Bet that psychiatrist in Philly gets put on leave for carrying a gun despite the result.<br /><br />Krav Maga gets people pretty capable in about three months. I agree that a couple hours would be just enough to put yourself in even more danger.<br /><br />It's very down and dirty and practical. No roundhouse show kicks, just things that work that the average person can do. Including women. Some of the female ex-Mossad I trained with were unbelievably tough.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-34649959660714130242014-08-01T18:26:06.218-05:002014-08-01T18:26:06.218-05:00I'm not sure what psych techs learn these days...I'm not sure what psych techs learn these days but in training to be one in the Army Reserves, I learned a few things. One time they has us all participate in a mock 4-point restraint exercise. One student, playing the patient, got a little out of hand and another student ended up with pretty substantial whiplash, neck brace and all. I learned then why medicating someone is safer than restraints, although I wish the meds used for this were a lot less harmful.<br /><br />For a more recent example, when I worked at a small town hospital there were no security staff. If a code was called in the pysch unit (small 18 bed), all the male personnel were to report to it except those in critical positions. Leaving aside the fact that pharmacists were considered to be in a critical position, I remember the time one young male pharmacist who was a bit drawn in by the all the excitement, yet also who truly did want to help, asked a pysch tech what he needed to do to be able to participate in a code I'll never forget what the the tech said, in a very deadpan tone to boot "Well, the first thing you've gotta do is get rid of that tie".RBnoreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-7626680332880383462014-08-01T02:34:57.470-05:002014-08-01T02:34:57.470-05:00I often wonder why residents and psych techs aren&...I often wonder why residents and psych techs aren't taught some basic Krav Maga to defend themselves if things turn ugly. It's what Israel uses to get the average recruit up to speed fast. Not to hurt anyone, but just self defense to buy some time or stun the attacker long enough to get away. When I was a resident we all knew a psych resident at a neighboring hospital who was killed by a patient with a fire hydrant. Choking is a primitive and potentially deadly attack that is easily neutralized and countered through some basic training.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-67750323133543037922014-08-01T00:37:40.568-05:002014-08-01T00:37:40.568-05:00"We don't like to admit that we're ba..."We don't like to admit that we're basically on our own to defend ourselves, but it's pretty close to the truth."<br /><br />I actually found it to be shocking the first time it happened. It is also quite disorienting to worry about whether or not to disclose the information and then get doubly shocked that even the people who are supposed to care from a clinical perspective either don't or they are ineffective. <br /><br />The only good news in all of that is that you rapidly become an expert and you can pass along what you know.<br />George Dawson, MD, DFAPAhttps://www.blogger.com/profile/03474899831557543486noreply@blogger.comtag:blogger.com,1999:blog-7772182113499451603.post-15179579460200404492014-08-01T00:24:10.150-05:002014-08-01T00:24:10.150-05:00At this point, I don't have a lot of faith in ...At this point, I don't have a lot of faith in the police. Elliot Rodger's parents tried to get the police to act but they kind of did an Officer Wiggum. On the other hand, some are into the SWAT mentality and overreact with firearms to minor or falsely reported threats.<br /><br />We don't like to admit that we're basically on our own to defend ourselves, but it's pretty close to the truth. Once the police are called, it's usually not to stop a crime in progress but to do the paperwork.James O'Brien, M.D.https://www.blogger.com/profile/14994350319492582321noreply@blogger.com