Making decisions for patient

[hamstergang]

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So a patient I'm seeing has divorced parents who can't seem to agree on anything. They have now presented me with a judge's decision that I am to be the one making medical decisions regarding psychiatric treatment for this patient, including the use of medications.

Anyone else ever in this situation? I'm not sure I feel very comfortable with it. I will run it by Risk Management, of course.

 

[WisNeuro]

That's weird. Why isn't there just a guardian appointed? Don't know much about the kid cases as I only run by these situations with adults who do not have medical decision making capacity

 

[Fan_of_Meehl]

Potential role conflict? One entity (you) simultaneously inhabiting the roles of: a) the MH tx provider offering a potential course of mental health tx and b) the 'decider'/guardian making consent and tx decisions on behalf of the minor patient? In such a case, would you both draft and sign your own informed consent paperwork?

 

[thoffen]

That is strange indeed. I wouldn't be comfortable with such an order and would probably try to transition the patient to another provider. As a general topic, though, I've found some patients who are trying to convey to you that they don't feel comfortable being tasked with self-care to the extent that you suggest. Sometimes it is better to acknowledge that and decide unilaterally on a treatment plan and define the boundaries for the patient as to their responsibility for communication of side effects, etc.

 

[shahseh22]

Which state is this? Seems very sketchy to me. Did you volunteer to be the decision maker? Is the patient a minor?

 

[hamstergang]

Which state is this? Seems very sketchy to me. Did you volunteer to be the decision maker? Is the patient a minor?

NJ. Patient is a minor. I did not volunteer nor even knew this was a possibility. Glad everyone else thinks this is odd too.

 

[Liquid8]

Seems strange. Surely the judge should have appointed a guardian if both parents have no capacity, but what they may mean is that they want you to decide what is the best course of treatment for the patient. Would have to know more details about what kind of interactions you've been having with the parents and what impact this has been having on care.

 

[TexasPhysician]

It is not uncommon for judges to word decision making like “Mother and Father have equal power to consent to care. In the event that the parents disagree, the physician is the tie-breaker.” This still involves a parent consent.

Is that how it was worded?

 

[hamstergang]

It is not uncommon for judges to word decision making like “Mother and Father have equal power to consent to care. In the event that the parents disagree, the physician is the tie-breaker.” This still involves a parent consent.

Is that how it was worded?

Nope, that would have been nice.

"Both parties will provide hamstergang with written consent for pt to begin psychiatric treatment.
Both parties will abide with hamstergang's determinations regarding pt's course of psychiatric treatment including, but not limited to, the doses of medicine and the type of medicine."

If a parent disagrees, they can pay for their own expert who will tell me why I'm wrong. If both parents disagree, they can jointly tell me.

 

[WisNeuro]

This sounds like a huge pain in the A. Good luck with that one.

 

[Shikima]

Contact Judge and talk with lawyers. Need a lot more guidance and information.

 

[notdeadyet]

Contact Judge and talk with lawyers. Need a lot more guidance and information.

\Agree. A family court judge should know better than this. There needs to be a medical decision guardian appointed. I wouldn’t be comfortable filling the role you’re describing. Too much liability, never mind the ethics.