GP Dr Ian Brooman was in his surgery one afternoon when a paranoid schizophrenic walked in and stabbed him between the shoulder blades.

This sort of life-threatening incident is rare, but it is estimated that one in four GPs has been abused, threatened or injured at work.

Now doctors are being offered self-defence tuition to help them deal with difficult patients.

Dr Brooman, a GP in Swanley, Kent, was stabbed in February 2000 by patient Matthew Richards.

Every year, some GPs are injured or killed by people who are violent

Dr Laurence Buckman, BMA GPs committee

He lost eight pints of blood, and spent five days in hospital. Mr Richards has been detained indefinitely in Broadmoor.

Dr Brooman, who returned to work as soon as he recovered, welcomed self-defence help for GPs.

"Anything which helps anger management is of use for family doctors who sometimes find themselves vulnerable," he said.

Dr Fred MacSorley, a GP in Lurgan, Northern Ireland, devised the self-defence tuition.

He told BBC News Online it was important for doctors to be able to defuse a potentially violent situation and arrange the layout of their surgery to reduce the risk of attack.

Avoidance

Dr MacSorley, who will present his work to the Royal Society of Medicine's Annual GP Forum in London on Thursday, told BBC News Online: "Northern Ireland statistics show it's the safest place for GPs to work.

"But we do find that there's a lot more verbal abuse from patients."

Dr MacSorley said he devised the self-defence classes because there seemed to be nothing available to advise doctors on how to protect themselves and their staff.

"The message is avoidance, to recognise the signs of impending violence in people, recognise their verbal cues, body language."

Unfortunately, society is not as tolerant of delays and difficulties in the NHS as it once was

Dr Fred MacSorley

He said GPs also had to ensure there was nothing in the consulting room that could be used as a weapon.

In the self-defence class, doctors are also taught how to extricate themselves if patients do physically attack them.

Dr MacSorley has also been subjected to violence. He was hit on the head while in his car on a visit to a patient and by intruders to his surgery.

"That was a very unpleasant incident because I had two people attacking me," he said, "I was OK, but what if I was a 65-year-old GP?"

He added: "Unfortunately, society is not as tolerant of delays and difficulties in the NHS as it once was."

Family threat

Dr Laurence Buckman, a negotiator for the British Medical Association's GPs committee, said: "I think self-defence classes are essential.

"Violence is an ever-present problem. Every year, some GPs are injured or killed by people who are violent."

Only two weeks ago, Dr Buckman was threatened by a patient who said he would kill the GP's wife and children.

He said: "Most violent patients are people with a mental illness, or they misuse alcohol or drugs.

"But sometimes, as with this guy two weeks ago, violence doesn't come from an expected source."

In March this year, the BMA warned family doctors were not being adequately protected.

It said only a quarter of health authorities had implemented a policy of zero tolerance against violent patients, where the most violent could be seen at a police station.