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Don’t get even, get angry!
  1. Colm O’Mahony
  1. Countess of Chester Hospital NHS Trust, Chester CH2 1UL, UK; dr.omahony{at}

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    “I’ll have you, you smarmy git; you’ll treat those faggots out there, but you won’t treat me.” That menacing threat was unmistakable. I was at a loss as to how to deal with this threatening 35 year old. He had become convinced that “some slag had given him syphilis” and he was demanding treatment for it. This was now the third occasion I had seen him and syphilis serology was repeatedly negative, as was everything else, but he had this fixed delusion. The other staff had the common sense to decline to see him but, as the consultant, I felt obliged to provide care. I arranged several appointments with Liaison Psychiatry and discussed the case with the consultant psychiatrist who described the situation as a common fixed delusion—a bit like a compulsive disorder. The patient, of course, didn’t attend any of these sessions and persisted in attending the clinic and threatening me. I felt helpless and found the situation intolerable, to the extent that all the fun had gone out of the job.

    At least I had the insight to understand that I wasn’t handling this properly and took myself off to Occupational Health, more in despair than in hope. The professional adviser saw me for several sessions. In no time at all she had brushed off the veneer of confident, coping, capable consultant to reveal an inadequate personality with no coping skills, low self esteem, and a profound inability to cope with anger. With extraordinary skill, she brought me to the realisation that this was a simple case of bullying—that is, I was the victim of an aggressive bully. These individuals have an unerring ability to seek out and harass individuals of low self esteem. One simple question during one of the sessions was the turning point when she asked me “Where is the anger?” At first, I resisted this—I’m a nice, compassionate, sympathetic doctor—I don’t do getting angry, especially not with patients, but still, it came back to the question—where is the anger? It slowly dawned on me that there is a time to be angry with the right person in the right place at the right time, and with the right amount of anger. I also found the book Self Esteem by Tony Humphreys extremely useful.

    Next time I saw the patient I insisted on having a security man in the room or I wouldn’t see him at all. This did not change his bullying tactics and when the consultation finished, I explained to security that I wouldn’t be seeing this patient again, and I had their agreement that the conduct was aggressive and constituted a risk to staff. I then contacted the outpatient services manager, and insisted he write to the patient, and to the GP, pointing out that the patient would not be seen in this clinic ever again. Should he attempt to do so he would be removed from the hospital. Twice more he did attempt to attend—the alarms were pressed, and the patient was humiliatingly marched off the site on both occasions. Bullying must be confronted.

    On a lighter note, the security service thought I needed a bit of training in “put down” techniques in case this individual was ever lying in wait for me in the car park or some other place. The idea was to teach me how to hurl somebody to the ground and then leg it for help. So, I and a trainee security officer went on this one day course and spent an exhilarating day hurling each other to the floor on protective matting. She was only a small woman, but it became obvious to me that size indeed does not matter after all! Under expert tuition, by the end of the day, we could resist each other’s advances, irrespective of force or direction. The technique is absolutely extraordinary and when brought into the home setting, greatly impressed my inherently violent and aggressive young twin sons. They now regard their old man with respect, awe, and wariness that hitherto was sadly lacking.

    So now, when threatened, the immortal words of Clint Eastwood’s Dirty Harry come to mind. “Go ahead punk, make my day.”