Suicidal patients

[anbuitachi]

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I know doctors have to follow the HIPAA rules and patient confidentiality stuff. However I'm not sure of the details of those rules. If the patient is showing intent of suicide, is the doctor allowed to call or tell someone for help?

Reason I ask this is because I want to write something in my essay about it as a dilemma. A friend showed intent of suicide or doing things to hurt himself. In the process, he gave me some stuff to pass along to his source of depression. However b/c i sensed that he might do something stupid, I opened his stuff myself and went thru it. So I ignored his privacy because I felt he might do something stupid like jump off a bridge or something. However, I dont know how medical school will view this if I write about it.. (will they think i'll be a doctor who'll break privacy rules? etc)

appreciate any comments, thanks

 

[Instatewaiter]

It's not really a dilemma, they have a duty in the event anyone is actively suicidal or homicidal

 

[anbuitachi]

what do their duties usually include? i mean do they have to think of ways to solve it by themselves or are they allowed to talk to others about it? thanks

 

[randomb]

what do their duties usually include? i mean do they have to think of ways to solve it by themselves or are they allowed to talk to others about it? thanks

If the doctor happens to be a psychiatrist, maybe. But a regular doctor should seek professional help for his/her patients if it's life threatening.

HIPAA was made to help patients, not harm them.

 

[the duck]

If the doctor happens to be a psychiatrist, maybe. But a regular doctor should seek professional help for his/her patients if it's life threatening.

HIPAA was made to help patients, not harm them.

um HIPAA allows for sharing of info with other medical proffs as is needed for the patients care....

 

[Drrrrrr. Celty]

If they have intent or suicidal thoughts then you don't do anything. If they have a plan then you have to intervene and can tell others. For example if you tell your psychiatrist you have a plan of how to commit suicide then he will intervene in whatever way he see's fit ( forcing the person into inpatient or the police).

 

[sustentacular]

If they have intent or suicidal thoughts then you don't do anything. If they have a plan then you have to intervene and can tell others. For example if you tell your psychiatrist you have a plan of how to commit suicide then he will intervene in whatever way he see's fit ( forcing the person into inpatient or the police).

OK, but as say a PCP if your patient expresses suicidal ideation (even if they aren't detailing a specific plan to kill themselves) you still have a duty to refer them to a mental health specialist.

 

[kevster2001]

If they have intent or suicidal thoughts then you don't do anything. If they have a plan then you have to intervene and can tell others. For example if you tell your psychiatrist you have a plan of how to commit suicide then he will intervene in whatever way he see's fit ( forcing the person into inpatient or the police).

Even without a plan, serious suicidal ideation is grounds for admission. If a patient in the ED told you: "I intend to kill myself but I do not have a plan" you can involuntarily admit them.

 

[orthomyxo]

Do you even know what HIPAA is? Someone's perceived intent to commit suicide doesn't really qualify as being personal health information. I could see how that would say something about their mental state, but I'm not sure that you'd be violating anything.

Obviously you would tell someone. I don't really see why there would be any kind of dilemma.

If they have intent or suicidal thoughts then you don't do anything. If they have a plan then you have to intervene and can tell others. For example if you tell your psychiatrist you have a plan of how to commit suicide then he will intervene in whatever way he see's fit ( forcing the person into inpatient or the police).

And this is bad advice.

 

[apumic]

If the doctor happens to be a psychiatrist, maybe. But a regular doctor should seek professional help for his/her patients if it's life threatening.

HIPAA was made to help patients, not harm them.

HIPAA and professional ethical codes do not supercede the Tarasoff case law (which largely established the HI/SI duty to warn). Whether or not a person is a psychiatrist or mental health-trained individual is irrelevant. Legally, there are a variety of professionals (including essentially all healthcare workers) who are required to report any HI or SI to authorities. Should the person carry through w/ the action and it is discovered you were aware of such plans, you will face some very stiff penalties (typically loss of licensure, possible prison time, etc.).

OTOH, I would not go looking for signs of SI beyond what is required of you in a given role. (I.e., going through your friend's stuff w/o his/her permission looking for signs of SI probably would not be appropriate from a legal perspective; OTOH, as a friend, it might be perfectly appropriate, depending upon the relationship.)

what do their duties usually include? i mean do they have to think of ways to solve it by themselves or are they allowed to talk to others about it? thanks

The duty to warn involves notification of authorities (i.e., the police). If the Pt gives consent, many agencies will also encourage the provider to notify the family. If a qualified individual (defined by state law) performs an evaluation and determines the person is an imminent risk to self or others, the person may be detained and treated for a period of 72 hours (or as defined by state law) on a legal psychiatric hold.

If they have intent or suicidal thoughts then you don't do anything. If they have a plan then you have to intervene and can tell others. For example if you tell your psychiatrist you have a plan of how to commit suicide then he will intervene in whatever way he see's fit ( forcing the person into inpatient or the police).

The presence of a plan is irrelevant. Only a qualified professional (as defined by state law) may make a determination concerning a hold. You, being unqualified, cannot make such a determination. A plan may or may not indicate the need for a legal hold or other "intervention;" however, as someone not qualified to make that determination, you would have to report it to appropriate authorities. People who can make such determinations in some states include: all licensed MDs/DOs, RNs holding a BSN and X years Psychiatric experience, police offers, LCSWs, LPCs, LCPs (doctoral level licensed psychologists), etc.

Even without a plan, serious suicidal ideation is grounds for admission. If a patient in the ED told you: "I intend to kill myself but I do not have a plan" you can involuntarily admit them.

"You" cannot unless you are a licensed professional per your state law. It would also be unwise even for a licensed ER doc to sign a hold on an individual prior to a psych eval. In reality, in most major EDs you have a psychiatric emergency/evaluation team that performs these assessments. Typically these teams have people w/ LCSWs (or similar) and years of experience, since their decisions put both themselves and the hospital in major legal jeopardy every day.

 

[apumic]

Do you even know what HIPAA is? Someone's perceived intent to commit suicide doesn't really qualify as being personal health information. I could see how that would say something about their mental state, but I'm not sure that you'd be violating anything.

Obviously you would tell someone. I don't really see why there would be any kind of dilemma.

Actually, it does. Intent to commit suicide falls under a psychiatric condition. To reveal this as a healthcare provider and without need would constitute a major HIPAA violation. What you are forgetting is that HIPAA does not apply to individuals not working in a healthcare setting that uses electronic records (and does interact w/ any organization that does use such records). Further, reporting SI or HI to authorities is a specific exception to HIPAA (as long as it is done in good faith).

As an example, I (being a healthcare worker and working under the RN license of the charge RN during my shift) cannot call a pt's family member to get a pt's girlfriend's #(assuming he does not have it or refuses to give it up) to inform her he has HI toward her. I can, however, speak with the girlfriend herself. The law provides the exception for her but not for the family. There are 3 ways I can get around this:
1) Get the Pt to give me permission to speak w/ his family concerning his case (in which case I can let them know why I am calling and ask them to get the #)
2) Contact the family w/o revealing any information and hope I can somehow get the information out without breaking confidentiality in any way (this can be done but it takes some serious social engineering)
3) Contact the authorities (i.e., call the cops) and give whatever information I have (this legally protects us but only if all other options are attempted first)