So first off, I’m a director of ops for a small clinic that performs ketamine infusions and spravato tx for pts with MDD and TRD. We also do ketamine infusions for pain.
I was on the phone with a potential pain infusion patient breaking down financial responsibility, explaining accumulations (deductible, MOP, etc…)
This pt was clearly under the influence of…something. Most likely opiates. I kept checking in with pt, and they verbalized understanding.
Now here’s the fun part. The pt sends a message in our secure messaging app insinuating that I missed our call. This person was so high they forgot our entire 15 minute phone call that had taken place just a couple of hours prior.
This app allows for internal notes as well as messages to pts. I had already entered an internal note immediately after speaking with the patient. Something to the effect of “S/W pt, went over financial responsibility…blah blah”
So I responded to then in the politest way I knew how. I let them know that “we had spoken on the phone”, and “did you have additional questions?” And didn’t want this woman to think I was gaslighting her, but we had in fact spoken on the phone just two hours ago.
I then put another internal note in stating that “when I was on the phone with pt, pt was slurring their words and seemed to be under the influence. I’m genuinely concerned they don’t remember our conversation.”
I then brought this to my leader’s attention (who is the co-owner of the clinic with his brother, our lead physician).
Cut to a few moments ago, my boss tells me that Dr. Bro is upset because I “expressed concern about a patient’s medical state” and now we are going to turn around and give them ketamine.
I stood my ground. I calmly stated, “I agree, non clinical personnel should not dx, tx, provide clinical advice, or misrepresent themself as clinical staff, no matter what their intentions are. However, at no point did I make a clinical determination of any sort.” He says he didn’t like the language I used of “under the influence” and how I expressed “genuine concern”.
I followed up with “so does my note make you rethink the appropriateness of this treatment?”
He said no, but we can’t have things like that in this official record.
I have been charting administrate my for years. I know that every time you record anything, you need to do it with the knowledge that one day that chart could get subpoenaed.
I’m finding it a little unethical that the doc is worried that me acknowledging a patient who was very clearly confused and high could pose an issue since we are providing ketamine tx. If that’s the case, then shouldn’t we not provide the tx for this pt?
So fellow healthcare professionals I’d love to hear your perspective. Do you think my note was outside the scope of my non clinical practice? Do you think this is a bit of a ethical gray area?
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