Deadly patient or just really angry? What one doctor did after a patient threatened to kill him

Some patients get disgruntled when they feel they’re not getting the results they wants. Others threaten to kill their doctors, and a few actually do end up doing just that. A Medscape News article recently recounted the experience of a San Diego doctor whose patient warned him he might come to harm if he takes the patient’s opioids away. The threat was apparently serious enough to alarm the patient’s ex-wife–who was also his caregiver–and two adult sons. "She made it very clear that he said he planned to kill me,” Dr. David Bittleman wrote in an article that was published in the Annals of Medicine. “I feared for my life because I took his threat at face value." Dr. Bittleman practises at the Veterans Affairs San Diego health system, where the patient–a former military man in his 60s–was being treated for musculoskeletal pain and mental illness. Read: Death threats: A line that has been crossed The death threat came after Dr. Bittleman suggested taking the patient off opioids, which he had been taking on and off for many years. "He had been maintained on oxycodone for chronic pain by previous providers, but I thought that was dangerous, given that he was mixing it with alcohol and marijuana," he said. "I met with him and a substance use disorder physician for a conference call, and we explained we would need to taper the medication and eventually stop the opioids." But the patient rejected the suggestion as well as Dr. Bittleman’s offer of inpatient care for treatment or withdrawal during drug rehabilitation. Shortly after the meeting, Dr. Bittleman received a warning from the patient through the health centre’s electronic messaging system. Read: Adding insult to injury? Doctor who suffered jaw, eye and brain injury from attack by MMA fighter patient ordered to pay court costs "You better learn jiu jitsu and hand-to-hand combat if you ever take my opioids away," the message read. "You better learn how to defend yourself!" Dr. Bittleman reported the message to Veteran Affairs police, who did not think the patient was dangerous. Two months later, the patient’s ex-wife told Dr. Bittleman the patient wanted to kill him. On the advice of police, Dr. Bittleman sought a restraining order. He was successful but not satisfied because the order was good for only two weeks. Read: Pain management: Tulsa shooting exposes threats doctors face The next step for Dr. Bittleman was to go before a judge and argue his case for a permanent restraining order. He went into the hearing anxious and fearful–the patient was in the same room, just a few feet away. "I was not sure I wanted to take care of patients anymore, especially chronic pain patients," he wrote. "However, I went for some counseling with the employee assistance program, and the therapist was helpful in normalizing my anxiety and acknowledging my fear. Prior to the hearing, some colleagues had suggested he get a gun or, at least, pepper spray. The judge at the hearing explained that the onus was on Dr. Bittleman to prove the patient was a threat to his safety. He showed the judge a copies of the patient’s message as well as a note from the ex-wife. Read: How to stop patient hostility The patient was asked to explain his side of the story. After listening to him talk about his problems with the hospital and the mental health treatment rehab that he “didn’t need,” the judge asked if he had threatened to kill Dr. Bittleman. "Oh yes, your honor, I did say that, but I was only joking," the patient answered. But the judge didn’t see the humour. He issued a restraining order that was good for one year and forbade the patient from owning and carrying firearms. The judge warned that if the patient disobeyed the order he would be arrested. "I never heard from the patient again," Bittleman said. "His [care] location was changed, and police were required to come to all his visits with his new provider. I was relieved that if he ever came near me, he was going to jail." Read: War is a health issue

Deadly patient or just really angry? What one doctor did after a patient threatened to kill him

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