Dear Lonny
I've worked in the same busy emergency room for decades.
The medicine and the patients haven't changed that much,
but the environment has got worse and worse. Where nurses
once showed respect for the docs, today they write letters
of complaint for less than nothing. For example, if
I ask nurses to get to the point when presenting a case,
or to hurry up an order during a particularly busy emerg
shift, not only do I get attitude at the time, I usually
get a complaint in my mailbox the next day. Most of
them don't even merit a response, but still, they're
unsettling. What do you recommend for dealing with trigger-happy
nurses?
Signed I've Had
It
Dear Had It
I hear your frustration, but if you allow complaints
to pile up — especially without an appropriate
response - you'll really have had it. Collegiality is
increasingly used as grounds for department chiefs and
Medical Advisory Committees' to recommend against the
renewal of a physician's privileges. And a file folder
of complaints — especially unaddressed ones —
will be just the record on which to base such a decision.
So your first step is to ensure that you've addressed
every complaint or negative comment made against you.
If you can create your own record of unfounded and unreasonable
complaints, then you will be better placed to respond
to such allegations in the future. But remember, you're
dealing with administrative, personality, professional
and even legal issues here — not medical ones —
so don't even think about responding to these types
of attacks without help from your lawyer. And, painful
as it may be, you may also want to have a good hard
look in the mirror and decide if all these nurses' complaints
are really "nothing."
NONCOMMITTAL
COMMITMENT
Dear Lonny
I'm a family physician and recently had the unpleasant
experience of committing a bipolar patient to a psychiatric
facility. He decompensated and represented a danger
to himself and to others, and I assured his distraught
family he could be treated quickly and effectively in
hospital, probably with antipsychotic medication. I've
now learned that my patient is refusing treatment, has
challenged the decision that he was not capable of consenting
to treatment and is appealing the Consent and Capacity
Board's decision in court. Meanwhile, he remains in
hospital without treatment. How can that be in the patient's
best interests? Is there anything I can do?
Signed Frustrated
on the sidelines
Dear Frustrated
I'm sure that all members of the patient's care team
share your frustration, but it's important to remember
that the decision to detain someone involuntarily is
distinct from the determination of whether the patient
is capable of consenting to treatment. The fact that
your patient met the test for involuntary detention
under your province's mental health legislation doesn't
mean that he's incapable of consenting to treatment.
A patient is deemed capable if he can understand the
relevant information and can appreciate the reasonably
foreseeable consequences of the decision. Healthcare
legislation allows patients to challenge these decisions,
and until their appeals have been disposed of, treatment
cannot be imposed upon them — even with the consent
of a substitute decision maker.
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Each month Lonny J Rosen, a partner
in the Health Law Group at Gardiner Roberts LLP, will
answer your burning medical-legal questions. Got a question
for Lonny? Send it by email to health_lawyer@nationalreviewofmedicine.com
or by fax to 514-397-0228
This column
is intended to convey brief and general information
and does not constitute legal advice. Readers are encouraged
to speak with legal counsel to understand how the general
issues discussed in this column apply to their particular
circumstances.
http://www.ontariohealthlaw.com
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