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In the latest mass shooting in the U.S., , a patient targeted and killed Tulsa, Oklahoma orthopedic surgeon Preston Phillips, MD, along with three others. In the wake of this tragedy, healthcare professionals said there is more that must be done to keep themselves, their colleagues, and members of the public safe.

Michael Louis, who had undergone back surgery on May 19, killed Phillips at the Natalie Medical Building on the campus of Saint Francis Hospital on Wednesday afternoon, said Tulsa Police Chief Wendell Franklin during a press conference, noting that police "found a letter on the suspect, which made it clear that he came in with the intent to kill Dr. Phillips and anyone who got in his way."

Louis, who "blamed Dr. Phillips for the ongoing pain following the surgery," entered the Natalie building armed with an AR-15-style rifle he had bought at a local gun store 3 hours earlier and a semi-automatic handgun he had purchased from a pawn shop at the end of last month, Franklin said.

Along with Phillips, Louis shot and killed another physician, Stephanie Husen, DO; a receptionist, Amanda Glenn; and a patient, William Love. The suspect then killed himself as police entered the facility.

As the hospital and community continue to , healthcare professionals said that while it may be difficult to predict each threat or situation that is capable of rising to such a level of tragedy, there are a number of risk factors that stand out, and there are specific measures that can be taken to prevent such events.

W. Michael Hooten, MD, an anesthesiologist and pain management specialist at the Mayo Clinic in Rochester, Minnesota, has studied patient-on-provider violence and hosted workshops on the topic. A former president of the American Academy of Pain Medicine, Hooten told 番茄社区 that there are key areas that tend to be more problematic, including situations in which a patient is dissatisfied with their care, when there are changes being made to care in the provision of opioids, or situations involving workers' compensation litigation.

When it comes to identifying potential threats, it's not just physicians who can raise a red flag for signs of distress, frustration, and erratic behavior among patients, but also nurses and the entire medical staff, including those checking patients in for appointments, he noted.

"When those threats are made, I would have to suggest that they're treated seriously because you never know which individuals may follow through with that threat," Hooten said. "Of course what we don't want to see happen is patients being refused or denied care unnecessarily. That's always the risk also -- that individuals may overcompensate. We don't want these events, as tragic as they are, to fracture the relationship between healthcare professionals and patients."

Following the Tulsa shooting, the American Medical Association (AMA) reiterated its call for gun violence prevention measures.

"As we have said repeatedly since declaring gun violence a public health crisis in 2016, gun violence is out of control in the United States, and without real-world, common-sense federal actions, it will not abate," said AMA President Gerald Harmon, MD, in a statement.

"The House Judiciary Committee is taking an important first step ... by considering the 'Protecting Our Kids Act,' and we urge members to approve life-saving measures and policies endorsed by the very physicians tasked with caring for victims of gun violence," he added.

The AMA noted that it included in the proposed legislation:

• Increasing the purchasing age for semi-automatic rifles from 18 to 21
• Banning the importation, sale, manufacture, transfer, or possession of high-capacity ammunition magazines and bump stocks and related devices
• Closing the "ghost-gun loophole"
• Creating federal requirements for safe gun storage and establishing strong penalties for any violations

Ryan Mire, MD, president of the American College of Physicians, also called for action.

"Our policymakers need to work quickly to come together on policies that will reduce firearm-related injuries and deaths," he said in a statement. "The gunman in Tulsa evidently purchased an AR-15 rifle the day of the shooting, the same weapon as used in many other mass shootings. These weapons, designed to kill and injure as many people as possible as rapidly as possible, have no legitimate civilian use; we reiterate our call on Congress and states to immediately ban their sales."

The shooting "also calls attention to the need to better protect physicians and other healthcare workers," Mire added.

Overall, healthcare professionals are keenly aware that the Tulsa shooting is hardly an isolated incident. In fact, on the same day this week, there was an unrelated shooting at an Ohio hospital. A after an inmate being transported to the emergency department at Miami Valley Hospital in Dayton took his gun. The inmate then killed himself in a parking lot behind the facility.

It can be difficult to get a complete picture of just how prevalent violence against healthcare professionals is, Hooten noted. "It's a reminder that we all must remain vigilant."

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