Hospitals, not fortresses

I am thinking about the events that occurred at the Johns Hopkins Hospital on Sept. 16. Apparently, a surgeon was providing an update to one of his patients about her condition; her son heard the conversation, pulled a semi-automatic handgun out of his pants and shot the surgeon on the spot, right there in one of the most famous hospitals in the world. All this because the shooter was apparently unhappy with the medical care provided for his mother. He then proceeded to use that gun to kill the patient and then himself, in the process terrorizing the hospital, its patients and visitors for the better part of a day.

I interact with our health care system as a doctor at this hospital, as well as being a potential patient and visitor, and I am left with an uneasy feeling about what this means for our society.

I see a parallelism emerging between our hospitals and other public buildings such as our schools, government buildings and airports. Are we now to consider hospitals to be in the same category as these locations — to be public places where one should feel safe but can't?

Think about our schools, long considered to be havens for our children but in recent times subjected to the brutal reality of school violence. Think about government buildings, where people should be able to feel safe to conduct civic business, only to be subjected to explosive acts of violence. Think about our airports, where people should be able to travel safely, only to be subjected to acts of violence so extreme that our society is forever changed as a result.

In response to acts of violence in these public places, society has reacted and changed by increasing security through such measures as limiting access with metal detectors and enforcing intensive screening procedures. This had led to a new philosophy regarding public places, from one of inherent societal trust to one of a priori mistrust. Granted, not all of our schools have a high level of security, nor should they; but the ones most at risk do. However, most if not all government buildings require security clearance to enter, frequently with metal detectors, and our airport security measures speak for themselves. In all of these cases, rare events have led to extreme responses.

The Hopkins shootings are just the most recent of a disturbing trend of violence in our health care system. While hospital violence is still rare, the Joint Commission, a hospital regulatory organization, recently published a report that violence in health care settings is on the rise, with an alarming number of these violent acts occurring in the last three years.

How is society supposed to react to this? Do we again apply a philosophy of a priori mistrust, securing our hospitals as we do our other public buildings? Hospital-based doctors and nurses go to work every day and interact with families of hospitalized patients. Sometimes we have to give very bad news to families, in situations that can become emotionally charged. As a hospital-based doctor, I am naturally now more likely to wonder whether these interactions will lead to violence toward me or someone in my unit. There are patient safety concerns at issue as well; hospital staff and visitors can take cover, but patients frequently cannot.

The doctor's relationship with the patient and the patient's family is based on trust. Our current societal norm dictates that hospitals are open to visitation with very little security. This openness is going to be rethought. Do we install metal detectors at our hospital doors, screen visitors and patients and risk alienating patients and their families?

I will resist the temptation toward this mistrust. I will continue to care for my patients and their families in the same way, and I hope my peers will too. It would be a societal tragedy to have to make hospitals inherently mistrustful places by turning them into fortresses, and I hope hospitals will resist the temptation to make policy to that effect. However, if hospital violence continues to increase, then this resistance may be futile.

Dr. Adam Schiavi is an assistant professor of anesthesiology/critical care medicine and neurology at the Johns Hopkins Hospital. His e-mail is