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    Violence against urologists: Data, communication needed

    Eugene Y. Rhee, MD, MBA Philip M. Hanno, MD, MPH

    Eugene Y. Rhee, MD, MBA

    Philip M. Hanno, MD, MPH

    In the last 11 years, four urologists have been shot by patients, two fatally. A fifth urologist was shot in 1994 and a Colorado urology clinic was the site of violence in 2012, when a gunman held three people hostage before being shot by police. In this interview, Eugene Y. Rhee, MD, MBA, discusses several of these incidents, the challenges of collecting and sharing data on potentially dangerous patients, and what some institutions are doing to protect their practices. Dr. Rhee is chief of urologic surgery at Kaiser Permanente San Diego. Dr. Rhee was interviewed by Urology Times Editorial Consultant Philip M. Hanno, MD, MPH, professor of urology at the University of Pennsylvania, Philadelphia.

    A 2010 report from the U.S. Bureau of Labor Statistics showed that nearly 60% of assaults between 2003 and 2007 occurred in the health care and social assistance setting, and nearly three-fourths of those assaults were perpetrated by patients or health facility residents. When we think of potentially dangerous patients, we tend to jump to the field of psychiatry. What makes the field of urology particularly at risk for the dangerous patient?

    That’s a good question. There isn’t a good reporting mechanism that shows the true incidence of this problem. There have been a disturbing number of gun violence incidents committed against urologists. However, in looking at statistics from the Occupational Safety and Health Administration and the Bureau of Labor Statistics, there’s no specialty-specific data on violent incidents.

    There has been a lot of discussion as to why these acts have occurred. In the four recent cases in which urologists have been shot, the commonalities shared are that the perpetrators were male patients over the age of 60 years who had a pelvis-related issue that led them to violence. They were dealing with quality of life issues: pain, incontinence, or erectile dysfunction. These men had adjustment challenges that led them to ultimately violent acts.


    Let’s discuss several of the high-profile examples of urologists who have been victims of violence. I know you’re familiar with Drs. Reynaldo Hernandez, Ronald Gilbert, and Charles Gholdoian. Can you comment on these cases?

    These particular individuals have sacrificed immensely, and some of them are not with us today. One of my good friends is a Seal team executive officer and I asked him how many members of his executive team have been lost or injured in the line of fire, and he said one over the last 10 years. I asked him, “What if I told you four urologists I know have been shot?” He replied, “You should really look at the scope of this.”

    Rey Hernandez was shot by a prostate cancer patient and survived. The gentleman had thought this out and planned it. It was a premeditated act.

    Ron Gilbert didn’t even know the patient who killed him. The shooter suspected that Ron had operated on him as a resident, which, it turns out, may not have been the case.

    In the incident involving the fatal shooting of Garo Gholdoian, another urologist, Dr. Christine Lajeunesse, was also shot and injured, as was a patient in the hallway of the clinic. The shooter in that case passed through the waiting room with a warning that patients should leave, and marched into the practice’s clinical area and started shooting. As in the other incidents, this was a premeditated event. It was not a spontaneous response to something.

    In discussing these cases, the point is not to sensationalize; it is to understand that we all have an obligation to create a safe environment. We are all leaders in our own practices, we all have employees, and we also have our own personal safety to worry about. Personal safety is a very personal decision. Everybody has their own mindset about what they should do to secure their office. I urge everyone to think very diligently about this, because steps can be taken to improve personal safety with not as many resources as you think you need.

    Next: "We must manage patient expectations."

    Philip M. Hanno, MD, MPH
    Philip M. Hanno, a Urology Times editorial consultant, is professor of urology at the University of Pennsylvania, Philadelphia.


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