Objectives: Physicians are at risk for patient-perpetrated violence. The objective of this study was to identify predictors for the hostile wish (HW): “I'd like to kill one of the doctors that I've seen” in acute pain patients (APPS) and chronic pain patients (CPPS).

Design: The HW question was utilized in the development of the Battery for Health Improvement (BHI 2) which was developed utilizing a healthy community sample (N = 1478), an unhealthy community patient sample (N = 158) and a rehabilitation patient sample (N = 777). Of the rehabilitation patient sample 326 were identified as APPS, 341 as CPPS, and 110 as having no pain. The APPS and CPPS were compared for the risk of affirmation of the HW statement Using BHI 2 scale, item and demographic variables using both t-test and chi-square. Significant variables (p<0.001) were then utilized as independent variables in logistic regression models for APPS and CPPS to predict affirmation of the HW statement.

Setting: Variety of settings.

Results: The risk for affirmation of the HW statement was increased above the healthy community sample by being non-healthy, being in rehabilitation, having any type of pain, and by having acute pain versus chronic pain, except in Worker's Compensation patients where this latter relationship was reversed. The risk for affirmation of the HW statement was also increased by having Worker's Compensation or personal injury status and most of all, by being in litigation. The final model chi-square for the analysis of the patients with acute pain was significant (χ2 = 54.8[6], p < 0.001) and this model classified 96% of the subjects correctly. The final model chi-square for the analysis of patients with chronic pain was significant (χ2 = 66.6[6], p < 0.001) and this model also classified 96% of the subjects correctly.