Thanks for your interest in our article Rowley. I
appreciate your concerns about the number of people
involved in managing a patient with DSH who refuses
treatment. I would suggest however that that is what
tends to happen in the in the war of attrition and
persuasion in convincing a patient that their best
option is to accept treatment.
The paper generated a lot of debate on the BMJ website
(bmj.com July 10 issue) which colleagues may find of
interest.
regards
Taj
--- Rowland Cottingham <[log in to unmask]>
wrote:
> I enjoyed the useful article from Leicester on the
> management of the
> patient with DSH who refuses medical care. (/BMJ/
> 1999;319:107-9) However,
> I was a little concerned to see that the algorithm
> that accompanied the
> article expected four different doctors become
> involved in her (used
> because the patient example is female) care.
> Initially she is seen by an
> A&E doctor (grade unspecified but probably SHO),
> then a psychiatric doctor
> (again unspecified, but a Consultant is probably
> required to Section her),
> a "senior" A&E doctor and finally a "second"
> (fourth) doctor to reassess
> and document competence.
>
> Surely this is overkill. I can understand the
> requirement to ask for an
> expert opinion on her mental state (although I doubt
> it would arrive with
> any great celerity) and certainly to inform the
> senior doctor on duty. But
> why this mysterious other doctor? Where does the
> nurse fit into this
> process - surely a hugely important part of gaining
> the patient's
> confidence can be performed very successfully by
> nursing staff. There is
> also no mention of emergency social work
> involvement, which would again
> probably be needed for Section, but can be another
> important part of the
> management of these patients.
>
> I appreciate that the point of the article is to
> alert doctors to the
> legal pitfalls, ensuring that they proceed without
> risking prosecution for
> assault and or battery, but I am uneasy that the
> algorithm represents an
> unrealistic and possibly unattainable course of
> action, excluding some
> important and useful sources of assistance.
>
> Best wishes,
>
>
> Rowland Cottingham FRCS (Ed) FFAEM
> Consultant in Emergency Medicine, Eastbourne
> District General Hospital.
> (UK)[log in to unmask]
> [log in to unmask]
>
> + (44) 1323 417400 Hospital
> + (44) 1323 414972 Accident Unit fax
>
>
===
Dr Taj Hassan
Dept of A&E Medicine
Leicester Royal Infirmary NHS Trust
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