When a patient threatens suicide?

[Impromptu]

Here is the scenario. You are seeing patients in the pre-op holding area. You hear a commotion coming from one of the rooms. A patient is yelling expletives at the nurses because the procedure is going to be delayed. Mothers in other rooms are covering their children's ears. She then loudly demands to see a doctor. You look down at your chart, then at the room assignment board, and you sadly realize that is the patient you are about to see. There is no junior resident nearby that you can pawn her off on. 20 or so years old. No previous medical information. Low risk endoscopy. You take a deep breath.

What do you do at this point? Talk with her? Call security?

You introduce yourself and deploy all the hostage negotiation tactics you learned from a lifetime of action movies. You empathize with the patient. You tell her that the nurses are just doing their jobs, that they don't have any control over the situation. She appears a little calmer, but there is still some rage underneath the surface, so you quickly gather health information. She states she has never been sick before, never takes medications. You spend a little more time on mental health issues than normal, but she is adamant that there is nothing. You have her sign the consent form. As she does so, she loudly proclaims that unless she starts within half an hour, like she was scheduled for, she hopes she dies during the procedure so that you and everyone else at this hospital get sued.

Your response?

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[deleted171991]

Good one. My response for an elective procedure would be to refuse doing it, right there on the spot. I don't care what her reason is; one doesn't get to threaten me with a lawsuit and get me to provide elective care. You can bet your a**, if anything happens, she will sue you.

She can complain to whomever she wants to. She should have been cancelled the moment she became verbally abusive towards the staff. I usually try to calm down things, even when verbally abused, but if you threaten me we're done. I have only had to walk away once, and another time the patient recanted and said she was joking, after I prompted her to repeat what she had just said.

I wouldn't interpret it as the patient threatening suicide, just as a very angry and entitled patient.

 

[Arch Guillotti]

Cancel.

 

[Impromptu]

It is most likely true that the patient was just angry. But, what if she goes home and commits suicide? Do you have an obligation to not just cancel the case, but to call psychiatry or even send her down to the emergency room? Involuntarily?