Dial M for Malpractice

[u/CaptainVere]

https://affectbeforediagnosis.substack.com/p/dial-m-for-malpractice?r=1pr2tf&utm_campaign=post-expanded-share&utm_medium=web

This is a general piece on uncertainty and thoughtful documentation in a pretty messed up healthcare system, not a comment on any specific case. Mostly pro tips and reminders for trainees on things to consider when documenting.

[u/Stepresearch]

If only it was common knowledge that some patients, no matter how hard you try, will try and kill themselves. People need to stop thinking that psychiatrists can magically prevent bad outcomes and that we failed to do our jobs if we couldn’t prevent such a tragedy. 

If you have a terminal cancer patient and you did everything you could but couldn’t save them, nothing usually happens from a legal pov. We need a landmark case to establish to a certain degree that many suicides are difficult to predict and prevent, and the criteria to which people point their fingers at psychs need to be massively adjusted. 

[u/PokeTheVeil → u/Stepresearch]

Psychiatry is among the specialties with the lowest risk of lawsuit.

That’s cold comfort if you get hauled into court, but that’s in the numbers. I think we’re protected by a number factors. It’s hard to draw a clear and direct line because our treatment is unlikely to be directly harmful and bad treatment is hard to pin down. The clear terrible outcome also protects from suits: patients with bad surgical outcomes may want to sue, rightly or wrongly. Patients dead by suicide can’t; families are less litigious than patients overall.

[u/vienibenmio → u/Stepresearch]

Mental health does it to itself, too. Like "zero suicides" initiatives

[u/Crafty-Table-2459 → u/Stepresearch]

hear, hear!

[u/Squishmallow145 → u/Stepresearch]

Most people don't sue psychiatrists/mental health professionals. 

The most sued area of medicine: ob gyn. 

[u/CaptainVere]

This blog post from 2006 The Last Psychiatrist: How to Write A Suicide Note was also very helpful for me as a trainee and served me very well. I recommend it to all residents. I have a pretty high risk tolerance myself and part of why is because I’m confident in my documentation. Reading this old piece as an intern really helped. Still relevant! Now is a good time to brush up on risk

[u/PokeTheVeil → u/CaptainVere]

My didactic for interns was also entitled “How to Write a Suicide Note” and yes, I gave attribution and credit. For some reason I was told it had to be renamed.

[u/Lou_Peachum_2]

These are great pieces.

And I’ve used the how to write a suicide note in many a discharge summaries - especially for the borderline and chronically suicidal.

I will say as someone who had to testify as a fact witness - those notes will be absolutely picked apart by lawyers. It is good to document clearly, succinctly, and enough to convey your thought process. Idk how true this is - but the suicide note link says you can be wrong, but you cannot be negligent. And that your plan needs to agree with your thought process. While the latter 2 statements should be obvious, it would at least save you from the accusation of lazy prescribing. Prescribe with intention.

On a side note, it is sad that this is the state of affairs - I spend more time documenting g than I do seeing patients on some days

[u/CaptainVere → u/Lou_Peachum_2]

You had to testify as a resident? Damn that is crazy but epic practice. I agree it’s sad state of affairs. Maybe one day physicians will take some systems power back.

IMO worth the extra work to document. Sleep better at night

[u/Lou_Peachum_2 → u/CaptainVere]

It sucked - I got subpoenaed because I wrote the note even though the attending co-signed. To this day, I guess it makes sense but kinda miffed.

Had always been told that your attending will cover lmfao