Excerpt From Medical Ethics: Real-World Application By Afshin Nasser

Mental Health

A patient with the clear capacity to understand, or one who clearly does not have capacity, does not need a psychiatric evaluation. However, a mental health evaluation can help in questionable cases to further assess capacity. For example, suicidal patients lack the capacity to understand as active suicidal ideation is a sign of impaired judgment. Or, a patient may have a history of bipolar disorder making it impossible for him/her to manage his financial decisions.

Share on facebook
Facebook
Share on twitter
Twitter
Share on linkedin
LinkedIn
Share on email
Email
Share on print
Print

A patient with the clear capacity to understand, or one who clearly does not have capacity, does not need a psychiatric evaluation. However, a mental health evaluation can help in questionable cases to further assess capacity. For example, suicidal patients lack the capacity to understand as active suicidal ideation is a sign of impaired judgment. Or, a patient may have a history of bipolar disorder making it impossible for him/her to manage his financial decisions.

However, the same individual might still be considered to have the competence to refuse treatment.
Most patients seen in primary care will experience one or more psychological or behavioral health problems during their lifetime. Although some patients need specialized care, primary care physicians should not discount the potential impact of taking time during office visits to consider brief behavioral interventions with patients who struggle emotionally or face life crises. Actions such as instilling hope, and using active listening can be powerful.

Physicians can also greatly influence patient willingness to follow through with referrals. With mental illness, however, the limits of primary care physicians’ roles are less clear. What is correct in the case that a patient is hearing voices or walks into the office and announces that he/she has decided to kill him/herself? What about a lawyer who’s having trouble meeting deadlines and asks for medication for attention-deficit disorder? Or the patient whose therapist told her to see her PCP about prescribing an antidepressant? Or the police officer who, after a shoulder injury, is trying to shake an Oxycontin addiction? The request for treatment in these cases is primarily due to a level of comfort with primary care physicians and lack of access to a psychiatrist.

Over a third of all mental-health care in the U.S. is now provided by primary-care doctors, nurse practitioners, pediatricians, and family practitioners, often because there are not enough practicing psychiatrists, thus, this burden falls on primary caregivers.

Download this chapter as a pdf

State Medical Boards

The medical board’s duty is to protect the public, not the physician. State medical boards today focus on licensed physicians who violate professional ethics, and their mandate has significantly evolved to focus on disciplining physicians.

Read More »

Boundary Violation

Boundaries create a therapeutic distance between physician and patient and clarify their respective roles and expectations. Boundaries define limits of the therapeutic relationship.

Read More »

Medical Ethics: Real-World Application By Afshin Nasser

You may have acquired this book as a result of conflicts with peers, administrators, patients, or State Medical Boards, where the outcomes of those interactions have left you wondering, “…what if I had done things differently?”

In that case, I hope that this book answers some of your questions and guides you with regards to any future quandaries you may encounter.


If you are a healthcare worker seeking to understand the subject of medical ethics, then I hope this book helps you acquire the clarity you seek.
If you are an individual simply curious about medical ethics, then I raise my hat to you for your pursuit of knowledge.