treating medical problems

[whopper]

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To what degree are you psychiatry residents &/or attendings expected to handle this?

In my own hospital, as I figure everywhere else since this is from what I understand a medical/legal standard-the primary doctor is considered the one always ultimately responsible. Fine, we understand this, and if the patient is in the psyche ward, that makes the psychiatrist the primary doctor.

So let's pretend the psychiatric patient under your care has a medical problem, one that the ER doctor overlooked and put the stamp of medical clearance on.

To what degree does your hospital subculture expect you to handle this? I've seen psychiatrists differ in their approach on this, even in the same hospital. Some psychiatrists feel that pretty much no medical problem, even simple coughs should be handled by them, which infuriates the internal medicine doctor showing up for the consult--in fact for this reason, the IM doctor will even ignore the consult.

Others, will be quite extensive in their care, pretty much doing anything that could be done on an outpatient basis, such as even treating pneumonia.

What's your opinion, and even better, do you know of any established legal standards for this practice?

 

[HiToday]

If you observe that the person has a disease and you fail to provide treatment (with the patients consent) and the person gets worse or dies or suffers pain that is a lawsuit which the patient or his estate will win. Your response to knowing letting the person die or get worse or suffer pain (unless that is the choice of the patient) because its not your problem is a lawsuit which the patient or his estate will win. The only exception would be if the disease required a specialty for which you are not compentant in which case you should immediately contact the proper person. No one would expect you to operate if you dont know how to operate but if you simply look the other way and dont get help (unless your patient requests it you will be liable. It doesnt matter what the hospitals subculture is. This is especially the case with psychiatrists who are holding persons prisoner. You are preventing this person from getting necessary medical care and your are liable for that. Even if it is the practice of your industry to knowingly harm people for money that does not excuse the liability. If that is the case the liability will not be simply malpractice but an unfair business practice for which you or your insurer will have to pay multiple damages.

To what degree are you psychiatry residents &/or attendings expected to handle this?

In my own hospital, as I figure everywhere else since this is from what I understand a medical/legal standard-the primary doctor is considered the one always ultimately responsible. Fine, we understand this, and if the patient is in the psyche ward, that makes the psychiatrist the primary doctor.

So let's pretend the psychiatric patient under your care has a medical problem, one that the ER doctor overlooked and put the stamp of medical clearance on.

To what degree does your hospital subculture expect you to handle this? I've seen psychiatrists differ in their approach on this, even in the same hospital. Some psychiatrists feel that pretty much no medical problem, even simple coughs should be handled by them, which infuriates the internal medicine doctor showing up for the consult--in fact for this reason, the IM doctor will even ignore the consult.

Others, will be quite extensive in their care, pretty much doing anything that could be done on an outpatient basis, such as even treating pneumonia.

What's your opinion, and even better, do you know of any established legal standards for this practice?

 

[Poety]

If you observe that the person has a disease and you fail to provide treatment (with the patients consent) and the person gets worse or dies or suffers pain that is a lawsuit which the patient or his estate will win. Your response to knowing letting the person die or get worse or suffer pain (unless that is the choice of the patient) because its not your problem is a lawsuit which the patient or his estate will win. The only exception would be if the disease required a specialty for which you are not compentant in which case you should immediately contact the proper person. No one would expect you to operate if you dont know how to operate but if you simply look the other way and dont get help (unless your patient requests it you will be liable. It doesnt matter what the hospitals subculture is. This is especially the case with psychiatrists who are holding persons prisoner. You are preventing this person from getting necessary medical care and your are liable for that. Even if it is the practice of your industry to knowingly harm people for money that does not excuse the liability. If that is the case the liability will not be simply malpractice but an unfair business practice for which you or your insurer will have to pay multiple damages.

wow, they don't even read the post they're responding to

 

[outofhere]

To stay on track, I think a psychiatrist should be able to know when to ask for a consult/curbside. If the IM person refuses to come, then document it, and cross your fingers... I don't know with certainty that a psychiatrist will not be held liable in court, however, I think managment of medical issues, fall outside of the psychiatrist's realm. I remember when I was an intern, there was an EKG that looked BAD! I didn't know how it was BAD, but it looked like nothing good. Anyway, I ran over to the medicine floor, curbsided an attending I had worked with, and she said to call cards stat. So I did, the the card dude raced up and took over. I think perhaps the lesson is that we should try to get along really well with the IM folks, so they don't mind helping us. And vice versa, when I am stopped by an IM person because their patient is blah, blah, blah, I will let them know if it is appropriate for a consult. I will have to say, that overall, the med/psych for the hospital I worked at, has a good relationship.

 

[Poety]

To stay on track, I think a psychiatrist should be able to know when to ask for a consult/curbside. If the IM person refuses to come, then document it, and cross your fingers... I don't know with certainty that a psychiatrist will not be held liable in court, however, I think managment of medical issues, fall outside of the psychiatrist's realm. I remember when I was an intern, there was an EKG that looked BAD! I didn't know how it was BAD, but it looked like nothing good. Anyway, I ran over to the medicine floor, curbsided an attending I had worked with, and she said to call cards stat. So I did, the the card dude raced up and took over. I think perhaps the lesson is that we should try to get along really well with the IM folks, so they don't mind helping us. And vice versa, when I am stopped by an IM person because their patient is blah, blah, blah, I will let them know if it is appropriate for a consult. I will have to say, that overall, the med/psych for the hospital I worked at, has a good relationship.

Curbsides are CRITICAL!

 

[Anasazi23]

It's fine to manage many medical problems, and is actually expected to some degree. An attending told us once that anything that we treat we are liable for. In other words, if you're treating someone's hypothyroidism, and some damage occurs, you are liable for that damage since you are the treating physician.

The same hold true for IM docs providing psychiatric treatment to their patients.

Our hospital also has a good working relationship with medicine, and we consult each other frequently. It certainly works best in that manner. There are often times where someone has a suspected infection, or a finding slips through the ER and is discovered on the floor. We often treat it ourselves, but find that if the treatment is not efficacious, or if there is a complication, or even if we simply want documentation in the chart that full and proper medical care was rendered, we call the appropriate consults.

 

[whopper]

Unfortunately several times when a consult is ordered in the psyche unit in my hospital-the corresponding doctor will not show up.

Now I realize that sometimes you don't exactly have to treat certain conditions because they aren't acute, and then you can shuttle the pt off the outpt treatment, but some of the cases were serious.

e.g. a pt who has been unconcious for 14 hours straight and now has an cyanotic arm, a patient with retained products from an abortion-and the OB-Gyn doctor will not see the pt because the doc doesn't want to open litigation to herself "I don't treat abortion patients, its too legally risky", leaving myself in a situation where I wonder what the heck will I do?

And then we got attendings who won't touch medical problems whatsoever.

I think this is a situation where I knew what the right answer was, but I needed outside verification becuase of the lack of consistency between the attendings I work with.