American Pain Society's 27th Annual Scientific Meeting (May 8 – 10, 2008): What Patient Variables Are Associated With An Expressed Wish to Kill A Doctor

8076 What Patient Variables Are Associated With An Expressed Wish to Kill A Doctor

May 9, 2008: May 9, 2008
East Hall (Tampa Convention Center)
David A. Fishbain, MD, FAPA , University of Miami, School of Medicine, Miami, FL
Daniel Bruns, PsyD , Health Psychology Associates, PC, Greeley, CO
John Mark Disorbio, EdD , Integrated Therapies, Lakewood, CO
John E. Lewis, PhD , University of Miami School of Medicine, Miami, FL
Objectives: Physicians are at risk for patient-perpetrated violence. The objective of this study was to examine hostility toward physicians by trying to identify predictors for the “Kill-MD Wish”: “I'd like to kill one of the doctors that I've seen.”

Design: A stepwise regression analysis using both community members and rehabilitation patients in treatment for pain or a physical injury was utilized to determine which of the Battery for Health Improvement (BHI 2) scales and items predicted the Kill-MD wish, and were subsequently cross-validated using a separate group of subjects.

Subjects: A total of 777 rehabilitation patients and 1487 nonpatients were used in this study.

Setting: Patients were obtained from a variety of physical rehabilitation and chronic pain settings in the United States of America.

Results: Rehabilitation patients as compared to nonpatients had significantly higher percentages (5.5% to 1.9%) affirming the Kill-MD wish. At cross validation, eleven BHI 2 variables explained 37.7% of the variance for the Kill-MD wish question: Anger with MD; violent ideation; suicide ideation; perceived harmful treatment; addiction to prescription medication; feeling dangerous; feeling forced to see a physician who isn't trusted; perceiving the physician as incompetent; having a suicide plan; hearing voices; and having spent more than one week in jail. The strongest single predictor was the BHI 2 Doctor Dissatisfaction scale, which explained 22.6% of the variance in the Kill-MD Wish.

Conclusions: There is significant hostility to physicians in certain rehabilitation patient groups as demonstrated by the frequency of the Kill-MD wish. Some of the Kill-MD Wish predictors are the same as previously identified violence/homicide risk factors. This study, however, has revealed some unique predictors relating to the patient-physician interaction.

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