It is no secret that doctors are not fond of lawyers. I do not hate all lawyers. I have met some very nice ones in my life. The ones that helped us close on property we bought and the one who helped us write our wills; those guys were okay. I hear that lawyers that represent families battling schools that are not providing appropriate services for their children with disabilities are pretty nice people. We deal with laywers in the risk management department who advise us on issues of medical ethics and cases that can be rather messy. Those lawyers are decent people. It is the malpractice lawyers that really tic doctors off.
I have not had the misfortune of ever having to deal with a malpractice case, and psychiatry is actually a low risk field for getting sued so we do not worry quite as much as, say, a surgeon or obstetrician. The lawyers we deal with and really get into conflict with are public defenders who work with patients in involuntary committal hearings and disability attorneys.
Disability attorneys annoy us for the reason that they are constantly pressuring us to fill out paperwork to declare patients permanently disabled who are not, and need to get a job. Some psychiatric patients need disability and are never going to be able to handle the stresses of a full time job, but most of them are capable of working, and really should. Being on disability is a barrier to getting well in fact. If one were to get well, one looses his source of support and faces an uncertain job market. Worse then that, he has to go to work and some people do not have the best work ethics in the world. Many people have gotten into the rather bad habit of watching a lot of TV and playing a lot of video games and are none to excited to change that pattern. I hate to say it, but it is true. I have worked in many states with very different types of communities and have seen this happen everywhere.
The other type of attorney that really gets psychiatrists goats is the public defender. Not that they are always bad, but for the reasons that we need to work with them. No psychiatrist enjoys committing a patient against his/her will, but sometimes it is necessary. The laws are much more strict than in the past to prevent abuse of patients, and if it is felt that a patient needs to be hospitalized involuntarily, there will have to be a hearing of some sort. Each state's rules on how this is done vary but have some similarities. One is that the patient has a right to be represented by an attorney, which most of the time is going to be a public defender. I would never imply that a patient does not have the right to appropriate legal representation in a committal hearing, but I will never attempt to commit a patient unless I truly feel that the patient is putting him/herself in danger by not receiving treatment or is a risk to society. Some PD's will see when a patient is really sick and not try to secure a really sick patient's release solely to say they won the case. These ones will often know when releasing the patient is going to potentially have very disastrous consequences (suicide, homelessness, bankruptcy, loss of home, family, life savings, etc.) and will not push too hard because often the patient is too sick to realize the risk him/herself. This is very commonly why we are seeking commitment in the first place. To try to help a patient with poor insight before he ruins his life and kills himself. Some PD's will fight to the death to get the patient released at all costs, regardless of how ill the patient is or how obvious it is that the patient needs treatment. Often in the case where the PD sees that he is fighting a losing battle, will start to ask rather ridiculous questions in order to catch the doctor off guard, often making himself look like an idiot in the process. I love those moments. I keep them cataloged in a special cubby hole of my mind to be brought up again at unit Christmas parties and anytime someone looks like they need a laugh.
Some of the best:
PD: How do you know the patient's homeopathic medication is not effective at controlling her symptoms?
Me: Well, she is here, isn't she?
PD: So you say that the patient could not come to the hearing because he refuses to wear clothes?
Me: Yes, that is correct.
PD: Is that a problem?(Not if he were Daniel Craig, but he was not, so yes.)
As a side comment, a social worker at the hearing who knew the patient told the PD "trust me, if you had ever seen him, you would know, yes, it is a problem."
PD: Tell me, if the patient's delusions were to turn out to be true, would she still need to be committed?
Me: Well, no, then she would not be mentally ill.
PD: Why do you think this man is a danger to his son?
Me: He is well established as an alcoholic and has been court ordered not to drink around his son, which he still does. Also, he has held his ex wife at gun point more than once and threatened to kill her.
PD: What makes you think that just because he will willing to kill his ex wife that he poses any danger to his son? (Maybe beecause he is a sociopath?)
PD: Exactly where is the danger in what she was doing that night?
Me: She was walking in the dark in a neighborhood with numerous "shooting galleries" and crack houses where there was a high risk of dirty needles being on the ground. She had no purse, cell phone, money or means of defense. She was barefooted. This is a high crime area where she is just a likely to be kidnapped and raped as be held up at gunpoint by a desperate addict seeking money for a fix. She had not slept in three days and was confused and had no idea what kind of danger she was putting herself in.
PD: Yes, but what has she done that is a danger to herself?
PD:You say that the patient has left the hospital two times before with a court order to take his medications and did not anyways. He told me that he would take his medications after discharge this time. What has he done to give you any indication that he would not take his medication after he was discharged? (If that was not proof enough, I had to respond.)
Me: He told me he was not going to take his medication after discharge this time. Has it occurred to you that he may have lied to you?
I save the best for last:
A big headed PD who had visions of being the next Perry Mason was trying to make me look bad during an appeal hearing by questioning my credentials. This is how this proceeded:
PD: Are you a licensed psychiatrist in the State of Pennsylvania?
Me: No, I am a licensed physician in the State of Pennsylvania.
PD: Whoa,whoa,whoa, now hold on there! Can you please explain to the court just why you are not a licensed psychiatrist in the State of Pennsylvania.
Me: Because there is no such thing as a license for psychiatry, we are physicians and licensed as such. I am a Board Certified psychiatrist if you have any concerns.
PD: (defeated) I have no further questions.
Me: In my head I was thinking "Can you explain to the court just why you are not a licensed dumbass in the State of Pennsylvania?" but I kept my mouth shut.
We had a really good laugh over that one. This attorney has since moved on to bigger and better things in the legal system but he continues to this day (even though this was years ago) to bear the moniker "Licensed Dumbass". When there was a hearing scheduled on the unit, the question, "Is the licensed dumbass defending today?" was often overheard. This is a fact that he may, or may not know but if he does, I really do not care. If the Foo Shi......
By the way, the licensed dumbass lost the appeal.
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