Is 24/7 availability really the standard of care?

[notdeadyet]

A consideration with the Google Voice idea is that Google does track/record/analyze all of its services, including phone calls (and text messages on Google phones). It may be at odds with HIPAA.

Aaaaaaaaamen. It would be a cold day in hell before I had anything to do with patient care on a Google product.

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[aphenomenon]

A consideration with the Google Voice idea is that Google does track/record/analyze all of its services, including phone calls (and text messages on Google phones). It may be at odds with HIPAA.

This doesn't include just having an android phone....does it?

 

[MarcusD]

Hm, very informative thread. I wonder what would the impact of all this information (which is public) might have on a suicidal patient in imminent crisis situation. A person in crisis may already feel like a great burden to family and health care providers and be well aware that their neediness is bothersome, feel unwanted, ect. Past ER experiences and prior hospitalizations for suicide attempts may be extremely traumatic for such individuals and would avoid any readmission. In addition, suicide hotlines and crisis intervention call centers have great limitations and may render inefficient when the "needy" patient may find some resolution only from a person that they have formed a strong therapeutic relationship. If that happens to be a rotating resident that may be annoyed or a burned out provider...anyways, I get the feeling there is a significant luck of compassion over here which indicates perhaps this is not the right field to be in. Having read all that - if i was a suicidal person in crisis would not even call for help and just follow through whatever plan. I am trowing this - just a thought - suicidal patients are real people in their weakest, most vulnerable moment with not much to loose.

 

[vistaril]

Suicide's not the only possibly emergency in psychiatry. What if a patient has a lamotrigine rash that's getting worse and worse over a weekend? ?

if it's really getting worse and worse, best evaluated by an er doc, derm, etc......in most cases psychiatrists just haven't seen enough SJS and other serious derm issues related to medication SEs to appropriately handle this situation if it is something that is truly concerning.....

 

[vistaril]

Given that one has to attempt suicide to complete suicide, a treatment that reduces the likelihood that someone will attempt also reduces the likelihood that one will complete suicide.
QUOTE]

not if it doesn't reduce suicide attempts proportionally across all the different suicide attempt populations

 

[splik]

suicide hotlines and crisis intervention hotlines do not reduce the risk of suicide anyway i am not quite sure what your point is MarcusD

 

[splik]

but they do not reduce completed suicide and thus do not reduce the risk of suicide (ideation, attempts are different outcomes, and it is misleading to lump them altogether)

 

[MarcusD]

My point exactly is about successful suicides. Calling a hotline to solve a "simple" issue centered around situational crisis may work but if the psychic pain is overwhelming, the generic treatment or problem solving that a suicide hotline may provide without knowing patients specific history, strengths, triggers, etc. would fail. What I mean is that the more complex chronic suicidal patient with long history of maladaptive behaviors will not benefit from such help. Plus, I believe if someone have really made their minds about such life and death issues there is nothing to stop them.

 

[splik]

well if you aren't familiar with the literature of these services and risk of completed suicide, then why are you arguing with me on this point?! they do not reduce the risk of suicide.

 

[splik]

These are old studies, but considering much of the classic literature still cited is old, and it the principles of suicide lines have not dramatically changed it is liked these studies (from the UK) still hold true. I am not sure if there are more recent ones:

Jennings C, Barraclough BM, Moss JR. Have the Samaritans lowered the suicide rate? A controlled study. Psychological Medicine 1978; 8:413-22
Barraclough BM, Jennings C. Suicide prevention by the Samaritans. A controlled study of effectiveness. Lancet 1977; 2:237-9

 

[splik]

well at least we can agree on one thing! i do think a recent large controlled study is needed, but for the reasons you mentioned and that most funding into suicide prevention is not really into 'prevention' at all, this is probably not going to happen anytime soon. However, I would be surprised if they did reduce completed suicide as this would be better that pretty much every psychiatric intervention that has been evaluated in this regard (which itself may be another reason this research has not been forthcoming).

 

[Mastac741]

...anyways, I get the feeling there is a significant luck of compassion over here which indicates perhaps this is not the right field to be in. .

This comment obviously shows how naive you are to the field. Give me your cell phone number, and I'll give it to all my borderline patients. We'll see how long your condescending attitude lasts.

 

[whopper]

It may be at odds with HIPAA.

As of about 3 years ago AAPL said it was not but Google Voice may have been more limited then. I haven't checked up on it since I don't use it.

 

[notdeadyet]

As of about 3 years ago AAPL said it was not but Google Voice may have been more limited then.

It's only been in the last 2 years that Google has revealed (or had revealed) how much data mining they were actually doing on users of all of their products. I'd be pretty surprised if AAPL would support its use today.

 

[whopper]

That's good to know and quite frankly I didn't know how much thought process AAPL put into it, but it was coming from their computer committee. I sat there during a session and the lecture, while interesting, was more on the order of -See this device, it's really cool. It could help out your practice."

Also, during that lecture, I remember it not even being out yet, but in the process of being given only to those who asked for it. I believe it was still in the beta version.

 

[MarcusD]

This comment obviously shows how naive you are to the field. Give me your cell phone number, and I'll give it to all my borderline patients. We'll see how long your condescending attitude lasts.

Ha! Naive - probably right! In no way I mean to be condescending. Based on your attitude, however, I would make sure I never get treated by you or anyone else that is so burned out if I happen to need help. Perhaps you need a brake and an attitude adjustment

 

[whopper]

Aw nuts, don't make me act as a moderator. Sometimes I feel like I have to be Marshall Dillon and that's not by choice. It forces me to have to tediously read every darned post before I feel justified enough to do a lock.