Guest guest Posted August 9, 2011 Report Share Posted August 9, 2011 Gang,Ok so I need some help here.As a clinician, what are my legal and clinical duties to a chronic pain patient that states that he is inches away from offing himself due to intractable chronic pain? He has been on a suicide watch (psych eval) before (several years ago). This patient is 40 y.o. and states that he "does not want to live like this for the rest of his life".I counseled him and we found some positive things to look forward to, but what else am I duty bound to do. I have not had this situation before. He trusts me and I do not want to breach this trust.Thank you for your input.Garreth MacEugene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 Garreth, I asked my husband, a Ph.D psychologist, about this one. It's a little bit of a sticky wicket. The doctor-patient relationship is a sacred one. A suicidal patient? Is he really suicidal. That's the 60 Million Dollar Question. If he is talking about it, he is thinking about it. Reasonable conclusion... You could 'confront' him straight on and ask him if he is serious about suicide, does he in fact have a plan. If he tells you what he PLANS to do or WHEN, you have some choices: You can tell him that you are deeply concerned and ask him if he would go to the nearest ER. You could offer to accompany him. You could ask if he lives with someone and does he give you permission to discuss this with that person. You could have the number of a crisis line or community mental health center available and offer to dial the number so he can speak with someone who can help. Or you can call (keeping his identity private) and find out what they recommend. In the end, even if he forbids you to do any of these things and won't cooperate, if your gut tells you that he is determined to kill himself imminently, you can call 911 or even contact a family member without his permission. Both of these options would be considered pretty extreme, but then suicide is pretty extreme... That said, he CAN turn around and report you for violation of his privacy rights. This would be reported to the Chiro Board and the charge would be investigated. Mostly likely you would be asked to write a statement explaining WHY you did what you did, without the patient's permission. A "good faith effort" to save someone's life would likely trump the confidentiality issue. Maybe a Board member can speak directly to this? Of course, he may tell you not to worry, he isn't REALLY serious and then go home and end his life. These situations are very fluid. Listen to your gut. DOCUMENT, DOCUMENT, DOCUMENT. The best protection for both you and the patient is to document your conversation/s. Put it all down on paper--your offers of assistance, his responses, what you did next, what he did next, etc. DETAILS. Then regardless of the outcome, you have documentation about what you did and why and what the outcome was. Sometimes there isn't a 'right answer' or a clear solution. But if this patient's life hangs in the balance, you have to weigh the relative risk of malpractice against doing nothing but 'talking' and having to live with the fact that you didn't try to stop him. I'd be interested to hear what others have to say about this. In the early days of my practice, I had a patient who mentioned suicide. She was deeply depressed, in a lot of chronic pain, lost her job and marriage. Really down and out. So I asked her if she was planning to commit suicide. She replied that she wasn't going to kill herself then, but that she had a gun and some bullets. Scared the bahoozits out of me. I told her I was going to follow her home to her apartment and that I expected her to give me the gun for safe keeping. Now, as an idealistic doctor new to medical practice, that was a pretty crazy thing for me to do. The outcome was that our conversation kind of 'snapped her out of it'. By being willing to confront her and not dance around the subject, it seemed snapped her out of her self-absorption. I told her that I expected her to contact me at any time of the day or night if she though she was in danger of killing herself, that I cared enough to hang in there with her and would take her to the hospital myself. But I never had to do that. She is now a counselor and is doing a lot of good in the world. A good outcome in her case. But, it could have ended very differently. Good luck. Ann DC Suicidal Patient Gang, Ok so I need some help here. As a clinician, what are my legal and clinical duties to a chronic pain patient that states that he is inches away from offing himself due to intractable chronic pain? He has been on a suicide watch (psych eval) before (several years ago). This patient is 40 y.o. and states that he "does not want to live like this for the rest of his life". I counseled him and we found some positive things to look forward to, but what else am I duty bound to do. I have not had this situation before. He trusts me and I do not want to breach this trust. Thank you for your input. Garreth Mac Eugene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 Garreth, My wife’s first husband committed suicide (he was also a good friend of mine). He was hospitalized the week before and they cut him loose with meds. partly due to his lack of insurance and both of them out of work would lead to a huge hospital bill (hospital staff’s words, not mine.) A common theme is that the meds. Elevated his mood slightly which allowed him to formulate a plan and carry it out. Depression will often incapacitate a person so that they can’t organize a suicide. Sometimes we have to make decisions based on what we could not live with if we failed to act. In this case, we have to error on the side of, “either you get some help and prove that you got it or I’m going to call and have you put on 72 hour eval.”. Easy to say; hard to do. If you are “a believer” and have the guts to do so, you can offer to pray for the person in their presence. Most people believe in God whether they say they do or not. I heard several atheists praying during National Boards! “God help me, I have no clue what the answer is!” Might have been a figure of speech. E. Abrahamson, D.C. Chiropractic physician Lake Oswego Chiropractic Clinic 315 Second Street Lake Oswego, OR 97034 503-635-6246 Website: http://www.lakeoswegochiro.com From: g macdonald <docgumby30@...> Date: Tue, 9 Aug 2011 20:42:05 -0700 (PDT) Oregon DC'S < > Subject: Suicidal Patient Gang, Ok so I need some help here. As a clinician, what are my legal and clinical duties to a chronic pain patient that states that he is inches away from offing himself due to intractable chronic pain? He has been on a suicide watch (psych eval) before (several years ago). This patient is 40 y.o. and states that he " does not want to live like this for the rest of his life " . I counseled him and we found some positive things to look forward to, but what else am I duty bound to do. I have not had this situation before. He trusts me and I do not want to breach this trust. Thank you for your input. Garreth Mac Eugene Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2011 Report Share Posted August 10, 2011 Garreth, I had a patient once say she was so depressed that she was going to commit suicide. She said she thought about killing her 2 children first then herself; so they wouldn't have to suffer without a mother. I called our board (OBCE) and asked their advice regarding HIPPA violations. This happened before I was a board member - over 10 yrs ago. I called a suicide hot line as well. All advised me to contact 911 and send the authorities to her home. I did so. THe patient was taken into custody, her children were taken into custody from the schools they attended. She was admitted for emergency psychiatric treatment. She was VERY angry with me. Her kids were temporarily put in foster care. She never returned as a patient. Her children were not murdered. She lived and received medical attn. I lost revenue. I never regretted my decision to call 911. I found the OBCE to be very helpful. Self-reporting with a question that needs immediate answer is always good in the event the case moves to a patient complaint. Minga Guerrero DC Gresham OR Suicidal Patient Gang, Ok so I need some help here. As a clinician, what are my legal and clinical duties to a chronic pain patient that states that he is inches away from offing himself due to intractable chronic pain? He has been on a suicide watch (psych eval) before (several years ago). This patient is 40 y.o. and states that he "does not want to live like this for the rest of his life". I counseled him and we found some positive things to look forward to, but what else am I duty bound to do. I have not had this situation before. He trusts me and I do not want to breach this trust. Thank you for your input. Garreth Mac Eugene Quote Link to comment Share on other sites More sharing options...
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