Monday, December 21, 2009

Patient Safety, Ethics, and Psychiatry

This fall I was asked to discuss a case for the Agency for Healthcare Research and Quality Mortality and Morbidity Rounds - a web-based patient safety education site.

At first I thought they were writing to the wrong Dr. Sabin. Patient safety isn't an area of my expertise. But the case they asked me to discuss had major issues of ethics and psychiatry that arose in the care of a homeless man with a history of IV drug use, admitted to a hospital with a methicillin-resistant Staphylococcus aureus (MRSA) abscess near the spine. The patient left the hospital against medical advice (AMA) with bad aftereffects.

I won't recapitulate the case and my discussion here. The moral of the story in the case I discussed was that homeless IV drug users are more "foreign" to most hospital staff than patients from "foreign" countries. Caring for people who we may see as "other" calls for distinctive cultural competence skills. When an institution lacks those skills safety is jeopardized. Ethics and psychiatric consultation can often be helpful.

(I read a number of cases on the website and found them uniformly engaging and informative. The AHRQ site is well worth visiting.)

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