A practical checklist most clinicians have never done!

We spend years learning how to create a therapeutic environment — the right chair arrangement, the ambient lighting, the box of tissues in just the right place. We think carefully about how the room feels to our patients.

We almost never think about whether the room is safe for us.

Most of us, if we’re honest, would fail a basic situational awareness test about our own offices. We couldn’t say with certainty which way our office door swings. Where other than usual exits are located. We haven’t programmed the local police number into our phones. We’ve never thought about whether a patient sitting across from us has easier access to the exit than we do.

These are not paranoid questions. They are professional ones.

The Four Things Every Private Practice Clinician Should Check

1. Know Your Physical Environment

Start with your door. Does it open inward and swing against the wall? This matters because a door that swings the right way can be used to barricade the room if needed. Next: Where are all the exits from your office, your floor, your building? Could you find them under stress? Have you ever actually walked them?

Then look at your seating arrangement. The standard clinical setup — clinician near the wall, patient near the door — exists for a reason. But here’s a nuance worth knowing:

Seating and panic buttons: a nuance

If you have a panic button, the seating calculus reverses. The patient should be closer to the door so that when help responds, you are not positioned between responders and the person who triggered the alarm.

Finally, remove potential weapons from the patient area. Heavy lamps, letter openers, anything that could be grabbed in a moment of agitation. We don’t think about this until we need to.

2. Set Up a Panic System — It Doesn’t Have to Be Expensive

iPhone or Android Phones

· Enable Emergency SOS right now. This is the simplest starting point and costs nothing: Set it up with your relevant contacts and medical information. It works silently; it’s always in your pocket, and most clinicians have never turned it on.

Wearable Safety Devices

· Silent Beacon or InvisaWear — discreet, doesn’t alert stalker that you have a safety device

· Apple Watch Emergency SOS programmed with emergency contacts — familiar device, always with them

Critical: Whatever device they choose, they need to practice using it. In a crisis, fine motor skills deteriorate.

Hands Free Safety Devices

· For those who want this option, wearable panic buttons that connect to your phone allow you to summon help without reaching for anything. Common options include Silent Beacon, Medical Guardian, and the Honeywell Panic Pendant.

Permanently Installed Panic Buttons

· For group practices or higher-risk settings, under-desk or wall-mounted silent alert buttons are worth the investment.

Video Surveillance is Discretionary

Calibrate it to your actual risk level:

• Waiting room cameras, you can monitor on a desktop are useful for moderate-risk practices — they give you advance notice of a patient’s state before they enter

• A hallway camera adds another layer of early warning

• A camera inside your office is rarely appropriate

If you use any cameras at all, patients must be informed.

3. Have a Communication Plan — Even If You Work Alone

· A communication plan answers a simple question: who does what when something goes wrong, before something goes wrong?

· If you have staff: who calls 911, who secures other patients, who meets the responders at the entrance? Do you have a code word for different types of emergencies — an agitated patient versus a medical emergency versus a fire? Have you ever practiced it, even informally?

· If you work alone: does anyone know your schedule? Is there a colleague who would notice and act if you didn’t emerge from a session on time? Are emergency contacts programmed in your phone?

· At the most basic level: have the local police non-emergency number and 911 in your contacts. Have the nearest hospital ER. Have a colleague you can call. None of this takes more than ten minutes to set up.

4. Screen for Violence Risk Systematically, Not Reactively

· Past violent behavior is the strongest predictor of future violence. Screen for it with every new patient. Document it. Update your assessment when clinical status changes.

· Before sessions with elevated-risk patients, do a brief situational check: How did they seem in the waiting room? Is today a high-stress date — an anniversary, a court date, a recent loss? Is something different today?

· And invest in de-escalation training. Clinical skill — the ability to read a room, manage your own anxiety, and reduce tension through language and presence — is your most powerful safety tool, far more effective than any technology.

A Final Thought

Situational awareness is not paranoia. It is professionalism.

We prepare for clinical emergencies — suicidal crises, psychotic breaks, medical events. Physical safety in our own offices deserves the same kind of systematic preparation. Not because danger is everywhere, but because preparation is what allows us to be fully present with our patients without fear quietly running in the background.

The full office safety routine — including checklists, a fillable emergency contact card, a monthly quick-check routine, and a violence risk protocol — is available as a downloadable resource below.

How prepared is your practice?

I’d welcome your thoughts in the comments.

Robert E. Feinstein, MD

Psychiatrist, psychoanalyst, and Professor of Clinical Psychiatry at Northwell/Zucker/Hofstra School of Medicine. Founder of Empathian, a mental health education company. This post is part of his ongoing series on clinical practice, training, and the human dimensions of psychiatric care.

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