Question for the practitioners

[IAMS]

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As a general question, open for exploration, how does a physician determine to treat a patient from their complaint, versus something else wrong with the patient. How far can you go? A few examples:

A parent who brings a child in multiple times with different complaints. (Munchausen's syndrome).

The patient who complains about headaches, but reeks of alcohol (smell listerine).

A patient wants an asthma medication refill, but obviously has undocumented mental psychoses / schizophrenia.

How far can you decide to treat these patients for otherwise obvious problems, when it isn't what they came to you for?

 

[emack]

Last time I checked you can't treat anyone for anything without their consent, eh? (Incompetent patients aside.)

What the physician should do (has a responsibility to do) is address other obvious or suspected issues with the patient & try to convince them that further investigation and/or treatment is in their best interests.

 

[IAMS]

Okay, I guess I wasn't sure how consent is always handled. If someone is deemed a risk to themselves or others, they need to be admitted by a close relative? How is this compromised with the patient's consent to be treated?

 

[deuist]

You have to define "risk to themselves or others." If someone is suicidal or homicidal--- I'm not talking about depressed. I mean that your patient is going to leave your office and immediately slit his wrists kind of suicidal---then you can call the police and Baker Act him for up to 72 hours. Likewise, if your patient is such a drug or alcohol addict that he poses a danger to himself, you can do a Marchman Act. (I think that Marchman Acts only work in Florida).

 

[emack]

There's still a very large gap between harm to oneself and needing to be 'admitted.'

For example, no one's likely going to try to force treatment on the alcoholic in your initial post. The Munchausen's person might have his/her kid taken away (a tricky process that should not be taken lightly), but will similarly probably not have forced treatment. The schizophrenic could be admitted to hospital against their will, but only if it was deemed they were posing real harm to someone else or significant harm to themself.

There are lots of things people do to harm themselves. There are very very few things that are considered dangerous enough to warrant treatment without consent.

There is a ton of ethical & legal literature on competence, consent, informed consent, proxy consent, assumed consent, etc. It's worth familiarizing yourself with the basic concepts, as well as how they're (mis)applied in the places you're going to be working.

 

[IAMS]

Okay. That sheds some good light, thank you so much.

Back to Munchausen's, where it is the parent who harms the child in order to get medical attention/sympathy, is this something where the physicians can just act based on legislation to admit for psychiatric care, or does another family member (husband, or otherwise if it is the mother) need to be consulted for consent to treatment? I'm also reminded of Andrea Yates, who drowned 5 children in a bathtub. There was some question if the husband was responsible for not getting help for his wife's post-partum depression. Would it not also be the physician's responsibility to spot the risk of harming other children, and to do something about it? (generally speaking, of course)

 

[RRGirl]

Okay. That sheds some good light, thank you so much.

Back to Munchausen's, where it is the parent who harms the child in order to get medical attention/sympathy, is this something where the physicians can just act based on legislation to admit for psychiatric care, or does another family member (husband, or otherwise if it is the mother) need to be consulted for consent to treatment? I'm also reminded of Andrea Yates, who drowned 5 children in a bathtub. There was some question if the husband was responsible for not getting help for his wife's post-mortem depression. Would it not also be the physician's responsibility to spot the risk of harming other children, and to do something about it? (generally speaking, of course)

Did you want to say post partum depression?

 

[IAMS]

Did you want to say post partum depression?

😱 yep 😀