Private Practice Emergency... Go Straight to the ER!!!

[prominence]

I have heard of several psychiatrists in private practice who despite being listed on various insurance panels advise their patients to go to the ER for any psychiatric emergencies after-hours. These private psychiatrists do not provide any beeper or other on-call contact numbers to prevent their patients from trying to contact them after office hours.

I know hospital affiliated outpatient psychiatric clinics cannot imagine this tactic, but can private psychiatrists shirk their responsibility to their private patients in such a manner?

Can such private psychiatrists be liable in any way with this type of private practice set-up?

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[Rhayven44]

I believe, and please correct me if I am wrong, that EMTALA does not apply to private practice offices. I seem to remember it does not affect the private physician in the same way it does a hospital or ED. Obviously, its a different story if the person shows up at your office bleeding from a gunshot wound and you slowly lock the door, but in terms of telling a patient to go to the ER if they have an issue, I believe that is legally OK. (morally is a different question, which I am too tired and cynical to debate today).

And to your last question...anyone can be liable for anything if the jury says you are
In all seriousness, nothing "protects" you from civil suits and whatnot, but I do not believe there is a sanction against this specifically.

 

[Doc Samson]

Agree - legal? yes. Appropriate? no. My wife is in private practice and has a phone set-up where callers to her voicemail can select non-urgent (she'll get the message whenever she next checks the mailbox) or emergent (the system simultaneously e-mails her, calls her cell, and calls the house until the message is retrieved). She is one of a very limited number of psychiatrists around here that do that.

 

[Sneezing]

I believe this is partially the result of what happens when you don't get paid enough. I bet the docs who aren't accepting insurance/medicaid/medicare are there for their patients. Same type of crap happpens with other specialists.

Surgeons opened ambulatory surgery centers. FM sends people to the ER after 5, unless they are cash only.

The solution is to tip the finances in favor of giving up sleep and family time. There are many ways to do this.

 

[atsai3]

Also may have to do with the difficulty of assessing over the phone. many psychiatrists around here are skittish about that. (Imagine hearing this at a trial: "so you thought he was moderate risk and did not insist on an in person assessment, doctor?" or, "how did you know she wasn't suffering from serotonin syndrome when you didn't examine the patient, doctor?") And so if for legal reasons you are always going to insist on in-person assessment and you don't plan on opening up your office in the middle of the night... I can see why a psychiatrist would simply tell someone to go to the ER.

-AT.

 

[kstotes]

I have to agree here. As I've tried to decide what direction to go w this one when I start private practice, I've again and again fallen back on the idea- what am I going to do with this information. Am I really going to do talk therapy over the phone? Am I going to attempt to assess my patients safety over the phone where there is no record unless I actually document for every call? Is there any scenario where I'm going to say- no I disagree you don't need to go to the ER? As for the 2am "I've run out of my klonopin HELP" I think being a patient infers some level of responsibility on patients and if they didn't know at 5pm they were going to run out, they can wait until the morning. People who don't want me as their psychiatrist bc I don't do overnight calls are probably the ones who would abuse it anyway. I will let all patients know that I leave 3 or 4 "emergency" slots open on the schedule every day and they are welcome to those. Hell, maybe I will even have a way they can reserve those spots online overnight to assuage their anxiety.