When trying to pursuade patients to accept treatment that seems medically appropriate, being able to categorize the types of thinking and logic patterns helps me avoid getting personally involved and emotionally caught up when a patient or family expresses resistance. You cannot make a good objective decision when your viscera are irritated, and that includes getting into “arguments” with patients.
Unfortuneatly, there are a very, very few situations when a physician, in conjunction with another provider such as a case worker, police officer or another physician can override a patient’s or families decision not to seek further care.
Last night I had one of those cases.
A minor had made a suicide attempt via overdose of a significantly large dose of over the counter and prescription medicines that necessitated cardiac monitoring, decontamination and consultation with pediatrics and the poison control center. After 8 hours, she was deemed medically clear for further management.
While this young girl may not have developed mature coping strategies to deal with the issues in her life, she was nevertheless able to make an independant (and unsupervised) decision to attempt to kill herself. We cannot send these patients home under any circumstances until a adequate psychiatric evaluation has taken place. In her case, both she and the mother wanted to leave without further evaluation of her actions.
I don’t know about you, but if I had a child who had made such an attempt, I would want to get as much help and input as possible to try and avoid future attempts and learn new coping strategies. The girl and her mother unfortunately had already made a decision to leave the department. BEcause they had already made up their mind, they were in no position to continue to participate in evaluation of the overdose. THey blocked all reasonable attempts to discuss the matter and the importance of further evaluation.
THankfully, state law allows me to set into action the necessarily steps to retain her in the hospital, despite her desire to leave. Her emotional pleas of “How can you have the heart to rip me of my family” didn’t penetrate very far into my thought process. In fact, they made me chuckle just a bit with the sad realization that her thought process was so short-sighted. She had no concept of the consequences of her actions. Unfortuneatly, when people do stupid things like this, they may lose some legal rights, just as she did last night. Mom learned a harsh lesson that she won’t always be able to bail out her daughter whenever she cries for help. She finally went up to the floor about 10 hours after arrival and after further unsucessful lobbying by her mother to take her home.