Intriguing Scenario

[narcusprince]

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So lets say you bring a pt back whom has had an epidural catheter. You give a 1mg of Versed, and and a small amount of background propofol lets say 25mcg per min. Pt is by all accounts comfortable, you start to speak to the pt and then he confesses a crime to you in that setting. What do you do as the physician?

 

[Dimoak]

Probably document the confession and then go see the hospital's legal counsel and risk management department.

 

[fakin' the funk]

So lets say you bring a pt back whom has had an epidural catheter. You give a 1mg of Versed, and and a small amount of background propofol lets say 25mcg per min. Pt is by all accounts comfortable, you start to speak to the pt and then he confesses a crime to you in that setting. What do you do as the physician?

Protect patient confidentiality unless there is clear/credible threat to others...no?

 

[proman]

Physician-patient confidentiality like FTF mentioned. Anyway, the confession would never hold up in court. I've had patient admit things under sedation (nothing criminal) that I just have pretended never hearing when I see them awake in the PACU.

 

[aredoubleyou]

increase propofol drip so you dont have to hear him talk, problem avoided

 

[MTGas2B]

HIPPA rules prevail, unless I'm responding to a subpoena.

I've been subpoenaed five times in residency, all for criminal cases, four times for victims and once for alleged assailant.

 

[Bertelman]

What do you do as the physician?

Unless its a murder/kidnapping/rape, etc, or it's Bernie Madoff, I do nothing.

I'm not sure if MD/Pt confidentiality proects admission of crime unless you are a psychiatrist (eg ED physicians report all gunshots). Even then, it can be broken if another's life is in danger.

Obviously the confession per se isn't allowable, but maybe he's not even a suspect in the crime, or the crime hasn't occurred yet. In that situation, I think the police would love to know.

 

[proman]

Each state has mandatory reporting laws that differ. I would only say something if someone else's life was in danger, or mandatory reporting. Murder, rape etc isn't included as far as I know.

 

[OB1🤙]

You people suck at this. The obvious answer is blackmail.

What exactly does the epidural have to do with anything BTW?

 

[urge]

I would call him at home with a deep voice and say: "I know what you did last summer..."

I'm sure a confession under sedation won't cut the mustard. Just put an lma if you don't want to hear about it.

I once had a priest that... and then I gave more propofol and that was it.

 

[Planktonmd]

This is a tricky ethical problem.
Unless what he told you will endanger someone's life (plan to commit a crime) I think you should ignore it.
You are a physician and you have the obligation to protect your patient's privacy.
Your encounter with the patient was based on a patient/physician contract (he trusts you, you treat him and do what's best for him), and if you disclose the information you learned while under that contract you are basically breaching the contract and acting against the patient's interest.

 

[jetproppilot]

I would call him at home with a deep voice and say: "I know what you did last summer..."

I'm sure a confession under sedation won't cut the mustard. Just put an lma if you don't want to hear about it.

I once had a priest that... and then I gave more propofol and that was it.

Please tell me you're kidding, Dude.

 

[Substance]

Lots of people say lots of things when they're hopped up on propofol.

I'd do nothing.

 

[Monty Python]

So lets say you bring a pt back whom has had an epidural catheter. You give a 1mg of Versed, and and a small amount of background propofol lets say 25mcg per min. Pt is by all accounts comfortable, you start to speak to the pt and then he confesses a crime to you in that setting. What do you do as the physician?

I ran this by a friend who is an ordained pastor of a recognized denomination. He was formerly an attorney before going to seminary.

1. anything the pt said with versed on board is subjective and fails to meet the rules of evidence.

2. the umbrella of confidentiality which applies to clergy, attorneys, and medical professionals with a duty to report can be broken only to report a verbalized planned future capital crime (child abuse, child porn, murder, etc.). Confidentiality cannot be broken for prior acts.

 

[bigeyedfish]

This exact thing happened to me CA1 year. It was a 50 something year old guy who was "retired" and now gambled full time. I asked him what he did that allowed him to retire so early and in the holding room he replied "import/export." I'm not kidding. No, it was not George Costanza.

After versed/fentanyl and prop at about 25mcg in the OR he confesses to me that he spent his life in the mafia, and made his money by stealing, extorting and basically being a thug . "But I never killed anybody."

To avoid having to join the witness protection program I pushed some more Vit V and upped the white stuff until he was snoring. Problem solved.

 

[stefanlukic]

Wouldn't hold in court.
Two reasons:
1. Patient-doctor confidentiality
2. Anesthesia - it would be looked on as a "verita serum" and very similar to torture which is banned and is considered "forced confession"