Over the past several years, physicians in private practice have been trying to ensure the safety of their secretarial staff. They're often the very first people who encounter a violent patient at the time of check-in, for example. Physicians are creating more barriers between the secretarial staff and patients.
Aside from that—as I had mentioned earlier—if the de-escalation attempts fail, often the only avenue that front-line physicians and the secretarial staff have is to call police. That's often after an assault or after the violence has already escalated.