Surgeons look to psychiatry to reduce the risk of patient violence

By Matt Kuhrt

In the face of harassment and intimidation from disgruntled patients, some surgeons have turned to psychological screening to ensure their patients' health needs aren't more mental than physical, according to an article on the Stat news site.

Among many patients, the trigger for threats and harassment can be traced to body dysmorphic disorder (BDD), which describes an unhealthy obsession with physical defects that are either imagined or minor, causing patients to seek out physical alterations when their issues are predominantly psychological.

The number of surgeons affected is jarring: 40 percent of cosmetic surgeons and 12 percent of dermatolocial surgeons report having been intimidated or harassed by patients who may have suffered from BDD, according to Stat.

As physicians and hospitals grapple with the rising potential for violence from their patients, there have been calls to be proactive rather than reactive in dealing with the problem. By the time doctors are making a decision on whether to pack a gun in the office, the argument goes, it's too late to help.

Some surgeons have turned to mental health screening tools in a bid to weed BDD patients out before surgery, effectively nipping the potential for violence in the bud. Because this approach typically involves a questionnaire, it offers a relatively easy way for practices to recognize patients seeking treatment that is either unnecessary or incapable of meeting their ideals.

While some have successfully identified BDD patients using these methods, others consider them far from foolproof. They don't work nearly as well as interviewing the patients directly, according to Mark Constantian, M.D., who tried the technique with his rhinoplasty candidates. "Patients filling it out wanted to qualify for surgery," he said, "and they understood what I was asking, even obliquely."

To learn more:
- read the article in Stat