Dr. Rebecca Smith-Coggins is a practicing emergency medicine physician at Stanford University Medical Center and the Associate Dean for Medical Student Life Advising at the Stanford School of Medicine. She has been an ardent cheerleader for physician wellness long before it hit center stage. Initially fascinated by the challenge of lessening the impact of the dark, ugly night shift, she wired up residents and attendings with EEG/EOG leads to study their sleep patterns. She started the EM residency at Stanford and was the first Residency Director for 12 years before she pivoted to the medical school environment and became an associate dean.  She developed, implemented and published a medical student mistreatment reduction program and has more recently taken on the worsening issue of patient aggression toward doctors.

In her FIX19 talk, she shares a personal story of an encounter with a violent patient that resulted in a swing and a miss by the patient.       

When did we sign up to put ourselves in harm’s way?  We have unwittingly discovered that we are poorly prepared and inconsistently supported to handle these tough interactions. She advocates for physicians speaking up and helping to end the violence that besieges our nation’s Emergency Departments.

Teaching de-escalation strategies and self-defense in our nation’s medical schools is beneficial for physicians and patients alike. Replacing the workplace trial and error learning approach with evidence based, learner engaged sessions would give us a toolkit of solutions.  Paraphrasing patient’s statements, setting clear limits and staying close to the door are just a few options that would enlighten our medical students. A video scenario based curriculum that is newly developed at Stanford University can be accessed for free here.

Dr. Smith-Coggins’ personal vignette illustrates the need for a dramatic culture shift in how hospital’s handle violence in the workplace. Increased resources for hospital security departments, widespread use of metal detectors, automatic debriefing sessions after threats of violence and “opt out” mental health care for those who are assaulted so that an appointment with a therapist is made and the individual has to actively cancel it are ways to potentially lessen the negative influences of workplace violence.  Utilizing a new debriefing strategy called “The Hot Offload” may prevent PTSD and can be accessed here.

She also emphasizes that it is imperative that we strongly advocate to abolish questions on state medical licensing applications that require a physician to report prior mental health care.  Presently, more than half of our states include these questions. Research shows that physicians were more likely to be reluctant to seek help when they were working in states where medical licensure requires answers to questions about prior mental health diagnoses or therapy. (1)

Violence must never be accepted as part of the job!  We must not accept what isn’t working!  It is time we advocate for everyone’s safety, so we are no longer in harm’s way.

Watch the FIX19 talk below!


  1. Dyrbye LN, West CP, et al. Medical Licensure Questions and Physician Reluctance to Seek Care for Mental Health Conditions. Mayo Clin Proc. 92(10). Oct 2017;1486-1493