“We’d like to admit you to the hospital if that’s okay with you”
my colleague says to the standardized patient.
She suffers from obvious postpartum depression
and her first line of therapy didn’t work.
She’s back for follow up, the practice interview of the day,
having contemplated, planned and poorly attempted suicide just the night before.
She reluctantly agrees to inpatient psych admission, a relief to the interviewing medical student,
and the case is over.
“I don’t know if you want to ask the patient if they are ok with being admitted to the hospital.
What if they don’t want to, but you have to admit them anyway?”
Our small-town private practice physician preceptor begs the question as a hypothetical to the group.
His question makes sense, as we are taught never to force anything onto our patients.
“Actually, what he did is correct,”
chimes in the guest psychiatrist sent to aid with the discussion.
He’s a brand new MD and knows the guidelines like the back of his hand.
“In Florida, at least, you are legally required to ask permission from the patient first.
Though you can involuntarily commit them if they express plans to harm themselves or others.”
It’s at that point that it chimes on me:
We’re overloaded with so much advice, so many ideas on how to be a better doctor,
how do we decide what to follow and what to ignore?
One doctor recommends keeping medical interviews strictly professional,
while one praises informal chit-chat.
One says dashes of empathy is enough, while one says to pile it on.
One thinks that living situation is vitally important, while one couldn’t care less.
One offers a supportive hug to all their patients, while one would never touch theirs.
How do we know which advice to follow and which to discard?
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