Are you prepared to handle combative and verbally abusive patients during your Ultrasound Fellowship training, even if they are spitting and forcefully removing things like IVs and catheters?

"My first concern would be safety. In a combative situation, this may require restraints for the patient and personal protective equipment for the personnel. If restraints are used, I will accept nothing other than the established emergency protocols in place. I recognize that dealing with such maladaptive behavior, even abusive behavior, is part of the job, so I intend to stay on task, regardless of how ugly the situation becomes. Obnoxious, threatening, self-injurious, and abusive behavior can never be taken personally in this environment."

The frequency of this occurring does not mitigate its seriousness. This is one of the most challenging types of patient care you have likely experienced as a resident and will as a physician in practice. Discuss your equanimity, self-restraint, and objectivity when dealing with a difficult patient. Don't hesitate to emphasize that you are aware of hospital procedures for security measures.