Yesterday I saw a sweet, frail elderly woman in my office. She was 93 years old and had a very good head on her shoulders. She had no signs of dementia and could vividly recall details of our last conversation. After examining her eyes, I determined that her vision was 20/70 in each eye with the best glasses prescription. She had irreversible macular degeneration that had progressed despite taking all of the preventative measures—seeing the retina specialist and taking the best vitamins on the market for vision protection. She begged me to renew her driver’s license: “I will lose all of my independence if I cannot drive. I have no one to help me. I need to get to the grocery store and I am unable to walk all the way there….it is just too far. Please doctor. Do something. I will fill out the form for you, so all you have to do is sign.” She failed the vision requirements to drive. I couldn’t approve her renewal.
During this encounter with my elderly patient, I had flashbacks about a call I received from a friend several years ago. My friend cried uncontrollably after finding out that her beautiful and brilliant twenty-year-old sister had died. Her sister was simply crossing the street and was instantly killed by a ninety-year-old driver. I remember my friend’s devastation. I remember her family’s devastation. I did everything in my power to support the family, but I could not get their beloved back for them. I thought about this terrible tragedy when my elderly patient was bargaining with me to let her drive. I thought to myself that this gentle, frail woman, who means absolutely no harm, could actually become a murderer—albeit involuntarily. I thought about my responsibility as a physician not only to do what is in the best interest of the patient at the moment, but to do what is in the best interest of society.
There is an overwhelming number of patients who walk into our offices who are threats to themselves or others…..patients who insist on having more pain meds, patients who contemplate hurting themselves, patients who are high on drugs who shouldn’t get on the road, patients with children who appear physically abused, patients who are combative and violent, patients who reek of alcohol early in the morning, patients with active sexually transmitted diseases, patients with evidence of self-mutilation, patients with dementia who are driving, patients who are wasting away from poor nutrition…..
How involved should we get as dentists, eye doctors, physical therapists, chiropractors, gastroenterologists, allergists……especially if we are not the patient’s primary care physician or family member? Should we react to these risky behaviors? Are they OUR responsibility?
As doctors’ reimbursements plummet, we must now see more and more patients to make ends meet. We are increasingly occupied with filling out trivial “meaningful use” paperwork on a daily basis to satisfy bureaucrats. These increasing demands on our time make it far more challenging for us to go above and beyond simply treating patients’ chief complaints. Now, doctors have even less energy and time to make the necessary phone calls and fill out even more paperwork to prevent at-risk patients from harming themselves or others.
What if, after reasonable suspicion, mental health providers had done everything in their power to hospitalize the Aurora Colorado and the Virginia Tech shooters before they became ruthless murderers? How many lives could have been spared? There were very disturbing signs early on that these young men were grave threats to society….one expressed the “desire to kill others” at an office visit, the other was stalking and harassing college girls and wrote horribly grotesque and violent essays in class.
Physicians are inadequate if all we do is simply “treat disease.” We have to think “beyond disease.” We have to think “beyond the clinic.” If we simply focus on protecting the patient-doctor relationship, we will also fail. If we truly want to be excellent providers, we must constantly question how our patients and their diseases can impact themselves and society. We must take immediate action when we feel that our patients are a threat to anyone. We will face challenges when we contact child protective services, inform unsuspecting family members about risky behaviors, or refuse to refill a patient’s narcotics. But, isn’t it worth the trouble when we can protect even one person from needless harm or death?
Indifference and acceptance could make our days go so much smoother. Patients may yell at us for saying “no” to them. They may threaten us if we refuse to comply with just one of their dangerous requests. But as socially responsible healthcare providers, we must remain steadfast. When it comes to protecting innocent human lives, there is absolutely no room for bargaining with patients.
The SocialDoc–Editorial Writer for DoctorCPR.com:America’s #1 Site for Medical Jobs + Pracitce Resources