Law enforcement may need to be contacted if an immediate or perceived future threat exists. In the event of an ongoing threat, a panic button may be helpful in certain practices if the anticipated risks are high. Dismissal from the practice should be considered if there are no indications of psychologically healthy responses from the patient. I find it helpful for my own state of mind to reframe, for myself, hostility and anger as manifestations of underlying fear. The hostility can then be seen as an expression of the defense mechanism that it more accurately represents.
Defense mechanisms arise in the presence of fear.
Once the hostility is reframed as fear, the physician is more free to experience compassion for the frightened patient. Often patients who are hostile have a story to tell and a need to be listened to. Compassion and care on the part of the physician can encourage the patient to formulate this story over time, and in telling it, to express anger in a way that is healthy for the physician-patient relationship. In this particular case, several specific diagnoses should be entertained. The mention of Vietnam certainly suggests the possibility of post-traumatic stress disorder or depression, both of which can manifest as hostility.