Fighting back

UP UNTIL the day she was attacked, in March 2007, everything had been going according to plan for trainee doctor Johannah Langmead. She had been successful in her studies at Newcastle, her Foundation year 1 was complete and she was halfway through her Foundation year 2. She’d already completed two hospital stints and was three months into a four-month GP slot at Prudhoe Health Centre, west of Newcastle. There she was holding her own surgeries and “really getting to grips with it”.

What’s more, the 23-year-old had got through the GP entrance exams, and the forthcoming interview was now the only thing that stood between her and acceptance on to a three-year GP training programme.

Then, out of the blue, disaster struck. “I’d just finished my afternoon surgery, so it was about 5.30pm, and all the patients had left,” remembers Dr Langmead. “I was closing up and thinking I might get off early, when this man burst into the room.”

The man sat down momentarily, but then got up and started waving his arms about ferociously and shouting. “I thought he was psychotic. But it happened so fast. I turned to pick the phone up to ring through to reception, but that was about as much as I managed before he hit me,” she says.

Long minutes

The attacker punched Dr Langmead repeatedly in the face, knocking her to the ground where he continued the violent assault. He later admitted it had been his intention to kill her. “The key thing in all this is that he locked the door,” she says. “Help wasn’t able to come in because they had to go and find the key, which was in reception.”

As a result it was several minutes before her GP tutor, Dr Donaldson, was able to gain entry and stop the attack, which left her badly bruised and swollen and requiring stitches to her forehead. “There was a possibility of a fracture, but it was all conservatively managed in the end, so I was quite lucky in that I didn’t have to have any operations. I had problems eating for a couple of weeks.”

The man, a practice patient whom Dr Langmead had never seen before, ran off but was soon arrested by police. It turned out he had been diagnosed with mental health problems some years earlier but had recently stopped taking his medication. In the days leading up to the attack, he’d been playing a violent video game, which it is believed triggered a psychotic episode.

In the aftermath, Dr Langmead was off work for nearly two months. “I did try to go back to work three weeks later but just couldn’t manage it at all,” she says. “I was just breaking down in tears all the time, at any little thing.” She did, however, manage to attend her GP interview eight days after the attack, bruised and battered and with two black eyes, and to secure her firstchoice job. Two years on, she can laugh about it: “But then everybody’s emotional at the interview, so I just kind of fitted in”.

Despite the time off, thanks to a good training record Dr Langmead was allowed to complete her FY2 and she has nothing but praise for the way her case was handled. “I couldn’t have asked any more of Dr Tiplady, the chief educational supervisor at North Tyneside. He was wonderful.”

She is equally full of praise for the counselling she received to help her cope with the psychological trauma. “The occupational health department at North Tyneside had a psychologist attached who was really very good. I had a meeting with her once a week. She helped me work through things.”

A more secure environment

It was the kind of random event you could never really be prepared for, says Dr Langmead, who is currently doing an ENT placement at the Cumberland Infirmary in Carlisle as part of her GP training. No amount of role-playing dealing with aggressive patients who are unhappy with a diagnosis or looking for drugs – training she underwent at university – could ready you for a sudden and violent attack of this kind. She didn’t even have time to think about the panic alarm under the desk – and with the door locked it may not have made any difference.

But having survived such an incident, it is hardly surprising that security at work is something she has thought long and hard about. Indeed, she admits she went to her last GP placement armed with a screwdriver. She laughs as she explains it was not for self-defence: “I had to take the lock off the door”.

Removing internal locks from GPs’ doors was one of the recommendations of a report prepared by Northumberland Care Trust into the attack. Others included positioning patients so there is always an escape route, and installing keypad-controlled doors from the reception area to the consulting rooms. But Dr Langmead is critical of the fact that, despite being acted upon by the Prudhoe practice, the report and its findings were not raised with other trainees in the Foundation programme.

“At no point was it ever mentioned to the FY1s and FY2s who were going into GP training, even from the cohort after me. I had a friend in the year below and there was nothing extra on security mentioned,” she says. “It could have been highlighted better, even if it was just a leaflet in the pack. The information wasn’t really disseminated outside the parties that were already involved.”

Dr Langmead never once considered giving up her GP training as a result of the attack, but she admits the experience continues to affect her to a degree. “I said I didn’t want to do a psychiatric rotation, so in a way it has affected my training. I don’t know if I’m ever going to be as comfortable with mentally ill people,” she says.

On one occasion, a man came into her surgery who resembled her attacker. “I had quite a big panic, but other than that it hasn’t really bothered me as much as I thought it would. I thought maybe any kind of 30 or 40-year-old male coming in might freak me out. But I take a couple of deep breaths and I get through it.”

She is keen that something positive should come out of her negative experience and says this is part of the reason why she agreed to revisit the terrifying episode for this article. She wants to raise awareness of the safety recommendations and urge fellow doctors to think carefully about their working environment. “I’ve told all my colleagues that they have to be much more aware of things like: do they have an escape route, is there a panic alarm, could they get locked in?”

At the same time she understands that it’s impossible to predict every eventuality – and difficult, too, to “waltz into a practice and start moving all the sockets and computers around” – but she believes that simple precautions and forethought really could make a difference.

She says: “I would hate for a similarly crazy, weird thing to happen to somebody else that could have been prevented.”

Adam Campbell is a freelance writer, editor and lecturer living in Edinburgh