Just had to request of a patient that he returns when he's not high on meth.

[Aristus]

I can't proceed with evaluation and treatment if he is legally incapable of consenting to it.

He was in altered mental status, blood pressure and heart rate markedly elevated. I told him to return when he comes back down.

He was cool about it. I told him I'll give him 100% when he's able to consent to treatment.

I'm happy to be practicing healthcare for the homeless again. But it has its pitfalls...

[CaliforniaPeggy]

1. I hope he complies, my dear Aristus...

And good for you for telling him how these things work.

[Aristus]

2. He was okay about it.

Even shook my hand on the way out.

Hope he shows up again soon.

[Orrex]

3. Asking because I have no idea...

When (if ever) are you allowed to proceed in a case like that? Is there some threshold point at which the patient is deemed unable to consent but still eligible for (or in need of) treatment?

Yikes. I don't envy you or people in your position.

[Aristus]

4. If life-saving medical treatment is needed immediately, there are laws to protect

a medical provider who is unable to receive consent for treatment.

But this was a fairly routine primary care case. But because it involved a specific type of examination, and lab testing (which is invasive: needle), I wasn't going to proceed until he comes in for a landing.

[Orrex]

5. Ah. Thanks.

I certainly don't question your judgment, and (again) I don't envy you!

[Saboburns]

6. Picky picky Doctor

Nust kidding.

I live and work in Appalachia's 'Ground Central' heroin epidemic. Which used to be pain-pill epidemic but has moved on to heroin, because it is cheaper to buy. Plus we have as much meth here as anybody else has. Lots of zombies walking around here these days.

[Aristus]

7. I have no doubt it's much worse where you are.

At least we have fairly good medical infrastructure around here. Our patients can get most of whatever treatment they need.

Governor Inslee has promised that if the ACA is repealed, Washington State will continue to ensure that the underserved will still have medical insurance. There are rumors that he's going to run for President in 2020. He's got my vote if he does.

[Saboburns]

9. Actually the powers that be are turning more and more proactive and open minded here

Hospitals, mental health facilities and law enforcement have been forced to work together, because no-fooling, per capita Huntington WV is the heroin capitol of the world. We routinely have days of 25 heroin ods, in our town of 50,000. Something around 30% of all babies born here are opiate addicted. When I say epidemic, I mean it.

But I will give credit, the powers that be are trying. Hospitals have started needle exchanges, law enforcement is trained and carries Narcan. And so many different agencies work together to fight it. Methadone and Suboxone clinics while numerous are all full. Its crazy around here.

[Aristus]

10. Is local law enforcement seeing the value of getting addicts into treatment instead of prison?

I hope so. And I'm glad to hear about the efforts to combat the epidemic.

[Saboburns]

12. Yes, very much so

Which is a 180 from 20 years ago. I must give LE credit on this as they have become very, very proactive regarding Tx over prison.

[rurallib]

8. When you have to do this do you fear they might react violently?

Putting myself in your shoes I would be quite concerned about an unexpected reaction, especially if they were in an altered state.

I think drunks would really concern me cause alcohol seems to enhance violent tendencies - or so i have seen.

[Aristus]

11. In all the time I've been doing this, I've only ever been threatened by prescription med addicts.

And always when they're sober. The heroin addicts are almost always very sweet. My meth addict today was cool and collected. No problem.

We used to have a security guard at our old homeless clinic. He was paid for by the city's development council.

Now that we have a stand-alone clinic, security would have to be funded by the company. So far, they're not willing to hire a guard.

[rurallib]

13. Thanks for this answer

this is something I have long been curious about.