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[at-l] Dangerous Doctors?



A psychiatrist is a physician. I also do forensic evaluations and 
consultation in malpractice cases. Primary care docs as well as specialists 
are occasionally sued following homicidal acts by patients. We see a 
increasingly common event of "suicide by police" in which the patient 
creates a crisis (such as a high school shooter) as a means of having 
others execute them. Frequently, these people have been seen by a physician 
within a few weeks of the crisis and the physician is seen as contributing 
to the tragedy.

What do I do if a patient tells me that they have firearms? I get more 
information about how many, how are they stored, prior gun play, and lots 
of other history. The gun is not the problem. The gun can contribute to a 
very big problem, just as the slip rug can. I am really too busy to add gun 
control or interior decorating to my schedule. Yet, I will try to elicit 
the patient and the family's assistance long before I call the Sheriff's 
office for involuntary commitment or Adult Protective Services for a home 
visit.

Each state has laws regarding involuntary evaluation and treatment for 
conditions that pose danger to the patient and the public. These are most 
commonly encountered in mental health, but are also invoked in infectious 
disease, delirium, trauma, immunization of children, abuse and neglect of 
children or seniors as well as other situations. The goal is to provide for 
public health and reduce the costs to the patient and society of untreated 
illness. It is very inconvenient for a physician to invoke such laws, and 
even more inconvenient if the physician neglects to invoke such laws. I 
rarely treat a patient I commit to hospital, as I believe that the patient 
needs a doctor that they are able to cooperate with in developing a 
treatment plan. I also know that involuntary psychiatric commitment make 
gun ownership illegal for that patient under the Brady laws. I have used 
that as leverage to assist a patient in becoming voluntarily admitted to 
hospital in emergency.

This is a difficult balancing act between individual liberty and 
responsibility against society's expectation of law and order and security. 
There is no way for competing interests of physicians, legislators, general 
public, law enforcement and others to be of one mind on this issue, much 
less every issue. The article cited in the journal for the American 
Association for Physicians and Surgeons (a very active and political group) 
was about as ill conceived as the JAMA article regarding adolescents' 
definition of "sex" before the Clinton impeachment. These were engaging 
op/ed pieces that should have been in the Spectator and New Republic 
respectively. They detract from the credibility of their guild publishers.

There are good reasons for physician's to understand prevalence of guns in 
our patients' households, seat belt use, immunization history, exercise 
habits and other personal data. Patients always have the right to leave the 
questionnaire empty or to lie. However, outcomes are often less 
satisfactory with either ignorant physicians or unreliable patients.

OrangeBug

At 11:36 AM 6/21/2001 -0400, Texas Twelve-Step wrote:
>The article wasn't talking about psychiatrists. Assessing
>"homicidal risk factors" isn't the job of physicians.