Rahul K Parikh: Violence against doctors in the US

Late last month, Stephen Pasceri walked into a Boston hospital and asked someone to point him in the direction of his deceased mother’s surgeon, Dr Michael Davidson. When he found Dr Davidson, Pasceri drew his gun and shot him. Davidson, age 44, a husband and father of three kids, would later die from his wounds.

Police have said very little about what happened. Pasceri committed suicide just after he committed murder, and thus, in the ensuing days, there has only been speculation about his motives and mental state.

This much we know. Pasceri, like so many Americans, was a do it yourselfer. That meme is usually reserved for folks who, proudly and diligently, build their own kitchen, restore a dilapidated automobile, or otherwise—with their hands, head, and heart—get the job done themselves. It’s a point of pride, a cultural moniker that, though not solely American, is attributed to us and celebrated by us every day.

Pasceri cruelly reminded us that this concept extends to guns in America. We in this country have, I would argue for worse rather than better, linked gun ownership to quintessential American values such as freedom and self reliance. The Second Amendment (the right to bear arms) of the US Constitution is defended by interested parties with such a political and rhetorical (and financial) tenacity that, at least in one instance, it has superseded the First Amendment (the right to free speech). Today, pediatricians who practice in the state of Florida are legally forbidden from asking parents about their gun ownership, a recommended routine to screen and provide anticipatory guidance about preventing firearms injury to children and families.

Still, even among the daily din of gun violence, the death of a doctor stands out in a chilling way—whether you’re in our profession or not. There are two reasons for this: studies show that, statistically, such an event is rare. Secondly, and more viscerally, the notion offends because it violates our schema. Physicians symbolize preserving life, not taking it. We wish to curb death and the suffering of others, not bring it upon them. A gun turned on a physician simply does not compute.

Yet violence, more generally, against all healthcare professionals is far more common than we might believe. Several years ago, I wrote about this. In the wake of Dr Davidson’s death, it resurfaces. Statistics at that time showed that over 71 000 doctors had been assaulted from 1993-99. Since then, subsequent data and trends have not shown much, if any, change from what I learned in my original review of the literature.

The “why” behind all of this is obvious to some, and perhaps less so to others. Certainly, news of a mentally ill patient who became violent against a nurse, physician, or other healthcare worker is the stereotypical story we may hear.

But the violence committed by patients and relatives might more commonly be explained by them reaching a boiling point after a long wait; prolonged discomfort or pain; financial issues (it was later revealed that Pasceri had a prior beef with the bills his family was charged when his father had a heart attack years before last month’s tragic incident); and any number of other frustrations that arise from the high cost of, and constrained access to, healthcare. It may even be triggered by the limits in our ability as doctors to provide substantial relief of suffering.

Sustainable solutions for preventing violence in healthcare settings remain tough to find and frustrating to implement. The provision of physical protection, such as metal detectors, has been inconsistent in helping to keep weapons out of healthcare settings. Meanwhile, training to find and prevent workplace violence, while having short term benefits, hasn’t proven to be effective in the long run.

After the 2012 shootings of elementary school children in Connecticut, the executive vice president of the National Rifle Association offered his own plan to curb gun violence. “The only thing that stops a bad guy with a gun is a good guy with a gun,” said Wayne LaPierre. Had LaPierre done a MedLine search before he declared this, he might have stopped himself. That same month in that same year, the study about emergency room violence (cited above) revealed that about a quarter of hospital shootings occurred as a result of the perpetrator getting the gun used from the security guard on site. The mere presence of a gun (good guy or bad guy, using LaPierre’s simplistic language) seems enough to engender a do it yourself tragedy.

Dr Rahul K Parikh is a physician and writer in San Francisco, California. He has published over 100 articles in print and online about medicine and society.

Competing interests: None declared.