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dwpineal
Psychedelic Artist



Registered: 07/20/06
Posts: 4,667
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Why Emergency Docs Test for Illegal Drugs Without Patient Consent
#13972369 - 02/16/11 06:58 AM (12 years, 11 months ago) |
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http://www.time.com/time/health/article/0,8599,2049555,00.html
Why Emergency Docs Test for Illegal Drugs Without Patient Consent
Do you know that when you walk into an emergency department, your doctor may run a test for illicit-drug use without telling you?
Yes, this is something we can and often do. And in many cases, it's done for a good reason.
Suppose you come in acting confused or excessively sleepy. Your doctors need to know right now whether your condition is caused by alcohol or drugs, or whether it's something else like a brain infection, a stroke or a seizure. Learning that you have a mind-altering drug in your system is an important piece of the puzzle — especially if you are too confused or incoherent to tell us what is going on. (See pictures of cannabis culture.)
Or let's say you come to the emergency department, flipping out — your family says they've never seen you like this before. If we test you for PCP and the result is positive, then we have a reason for your erratic behavior, and now we might be able to spare you a spinal tap (to look for that brain infection) or avoid artificially paralyzing you to keep your head still in the CT scan (while looking for that stroke).
So there it is — emergency-care providers must have the ability to obtain rapid laboratory drug-of-abuse tests on demand. These drug screens are an essential tool in our diagnostic kit, enabling us to take care of our patients and protect public health.
Of course, it isn't so simple. There are some real tradeoffs to testing emergency-department patients for illicit drugs. As practitioners we need pay attention to the downsides of these tests so we don't overuse them.
First there are ethical issues of autonomy and confidentiality. The principle of autonomy states that patients should be able to decide whether or not to undergo testing or treatment for anything. When you check in to a hospital, you sign a form giving consent for routine testing, including blood and urine tests for lots of things. This makes sense — it means that as doctors, we don't have to check with you for every run-of-the-mill test we order. But the question here is whether or not testing for drugs and alcohol without your explicit consent should be considered routine.
Confidentiality is, of course, the other major ethical problem with ordering illicit-drug tests on our patients. While the Health Insurance Portability and Accountability Act legally protects all medical information from public disclosure, just ordering the test increases the risk that a breach of confidentiality could expose this sensitive information.
False-positive tests are another concern. Urine drug tests use immunoassays to screen for multiple illicit drugs. While they tend to be quite accurate, cross-reactions with other medications have been demonstrated — for example, over-the-counter decongestants have been shown to light up the amphetamine test incorrectly. Also, these tests may identify previous drug use but fail to tell us that the patient was using drugs recently (the marijuana test can be positive over a month after use, for instance). This can be confusing to the diagnosticians who are trying to figure out what is causing today's symptoms.
Last, there are issues of cognitive biases, mental prejudices on the part of doctors that can interfere with our ability to make the best decisions for our patients. Fundamental attribution error is one such bias, in which a health care provider inadvertently — and wrongly — blames a patient for her illness. Take the case of the patient with belly pain, who tests positive for cocaine: she becomes the "drug user in Room 2."
On one level, this categorization may be helpful — it reminds me to discuss drug addiction and counseling options with the patient. But it also can undermine her care. As a practitioner, I may develop a sense of futility: whatever we do to fix her immediate problem isn't going to help because she is just going to go out and continue to abuse her body and mind. Now she is given a lower priority on my giant to-do list, which is wrong. Priorities in care should be determined by an unbiased assessment of urgency. A positive drug test can scramble this order.
The downsides of emergency-department drug screens become even more apparent when we consider that the benefits of ordering the test are often unclear. Take chest pain, for instance, the second most common reason for seeking care in an emergency department. Chest pain associated with cocaine use can be due to spasms of the coronary arteries. These spasms may be made dangerously worse when we give beta-blockers, a commonly prescribed class of medication for patients with heart-attack symptoms that are not caused by cocaine use. Because we know that many patients presenting with chest pain will not self-report cocaine use, conventional wisdom holds that drug-testing these patients is a good idea. It allows us to figure out who should and shouldn't get beta-blockers. The problem is, there's no evidence to suggest that doing clandestine cocaine tests actually saves lives, or even improves patient outcomes.
Similarly, we often run drug screens on patients who come to the emergency department with psychiatric complaints like acute depression. Then we have to wait for hours for the results before we can proceed with their care. Yet studies have shown that getting drug tests makes no difference in the subsequent psychiatric care and treatment of these patients.
So what is the solution? Legal or regulatory barriers to drug tests are a bad idea. When patients are very sick or acting completely wacky, the screens are essential. Sometimes we can give antidotes. Often we can hone in on our diagnoses. But we also need to stop ordering drug screens for patients who don't need them. A good rule: if it isn't going to change your management, don't order the test. And even if ordering that test might change your care, consider other options like simply asking patients if they use drugs before undermining their trust. Just like everything else we do in medicine, the risks and benefits need to be weighed ahead of time. Drug-testing needs to be put to the same measure.
Dr. Meisel is a Robert Wood Johnson Foundation clinical scholar and an emergency physician at the University of Pennsylvania.
Read more: http://www.time.com/time/health/article/0,8599,2049555,00.html#ixzz1E887fXU3
Edited by dwpineal (02/16/11 07:38 AM)
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jacobensis
captain


Registered: 01/15/11
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: dwpineal] 1
#13972413 - 02/16/11 07:20 AM (12 years, 11 months ago) |
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look man- if i come into the E R acting like a nut job: please test me for everything! i have a high tolerance for alot of illicit drugs so i know i wouldn't just show up to chat. i think drug testing is a great tool used to save lives. And we all need to remember its not illegal to use drugs. unless you live in a state that has that communist internal posetion law, but then you have doctor/patient confidentiality to protect you.
-------------------- There are 2 types of people, mycophobes and mycophiles R.Wasson
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German Kahuna
Facepalmer of Stoopid



Registered: 10/31/08
Posts: 15,798
Loc: On a Chemical Vacation
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: jacobensis]
#13972461 - 02/16/11 07:37 AM (12 years, 11 months ago) |
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Absolutely. There are several reasons why these tests are a good idea. What if they need to administer some medication or another and there are strong contraindications for certain substances. A few weeks ago here in Germany some porn starlet died during anesthesia while getting a boob job, because she didn't tell the surgeon and the anesthetist that she was taking all sorts of meds.
-------------------- "Vegetarian" [ /ˌvedʒəˈteəriən/] - Ancient slang meaning "village idiot who can't hunt, fish or ride".
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Le_Canard
The Duk Abides


Registered: 05/16/03
Posts: 94,392
Loc: Earthfarm 1
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: German Kahuna]
#13972492 - 02/16/11 07:52 AM (12 years, 11 months ago) |
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I agree with both of you. They're just trying to help the patient as best they can, it would seem to me.
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guest1
Mycena




Registered: 05/25/09
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Le_Canard]
#13974082 - 02/16/11 02:56 PM (12 years, 11 months ago) |
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As long as they don't call the cops for being under the influence and are only trying to understand what your problem is and how best to treat you and as long as their not disclosing the information, I don't see the harm. I have been given a drug test when I had a serious problem and they said "don't worry, were not the cops, were not going to arrest you or anything if you test positive for any substances". I pretty much knew why they requested a urine sample, so I didn't bother to ask, but i'm pretty sure if I had asked, they would have told me. Also, before they requested the sample, they asked if I was under the influence of anything. My urine came out brown, which worried me because I had never had that happen before and made me very worried. Later I read online it can be a temporary liver problem, which I think it was. The only problem is, they really didn't do anything but monitor me and my vital signs and give me a ridiculously large bill to pay.
I told them I just wanted to know if there was some way they could do something to find out if I was going to be OK or if I was going to die and if I was going to be fine, I would have just left. I believe they were not educated on the problem I had, and so they did routine procedures for un-educated problems.
Until you experience something similar to this, it is easy to have a belief that doctors and such, have all the answers and know what to do in all situations to best treat all possible problems, but the sad fact is, they don't and just do their best with what they do know. They also don't want to be held liable later for letting you leave while your "out of your mind" and you "think" your fine but really your not and later try to sue them for mistreatment I guess... (Like if you were on a high dose of PCP or whatever, which I've never done and never will.).
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cc2
Mush

Registered: 05/15/10
Posts: 2,611
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: German Kahuna]
#13974311 - 02/16/11 03:44 PM (12 years, 11 months ago) |
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Quote:
German Kahuna said: Absolutely. There are several reasons why these tests are a good idea. What if they need to administer some medication or another and there are strong contraindications for certain substances. A few weeks ago here in Germany some porn starlet died during anesthesia while getting a boob job, because she didn't tell the surgeon and the anesthetist that she was taking all sorts of meds.
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icanttype
Lurker


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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: German Kahuna]
#13974424 - 02/16/11 04:08 PM (12 years, 11 months ago) |
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Quote:
German Kahuna said: Absolutely. There are several reasons why these tests are a good idea. What if they need to administer some medication or another and there are strong contraindications for certain substances. A few weeks ago here in Germany some porn starlet died during anesthesia while getting a boob job, because she didn't tell the surgeon and the anesthetist that she was taking all sorts of meds.
she was pretty hot too
-------------------- GGTBod - "Sounds great, get trippin get naked and get animalistic make her laugh and piss all over you, i see no problems here "
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Humility
Working on it



Registered: 10/07/08
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: icanttype]
#13974956 - 02/16/11 05:47 PM (12 years, 11 months ago) |
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Hospitals and doctors do a lot of things without consent.
None of it should be done.
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cc2
Mush

Registered: 05/15/10
Posts: 2,611
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Humility]
#13979088 - 02/17/11 02:21 PM (12 years, 11 months ago) |
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Quote:
Humility said: Hospitals and doctors do a lot of things without consent.
None of it should be done.
so would you prefer to die 'cos they didn't test you and their anesthetic did interfere with your drugs?
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Humility
Working on it



Registered: 10/07/08
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: cc2]
#13979239 - 02/17/11 02:54 PM (12 years, 11 months ago) |
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LOL FACEPALM!
You're the one arguing for someone doing something non-consensually to another person and pretending like it's this "necessary evil" that the world couldn't do without.
Axioms are axioms for a reason.
If you want something to be done with you when you can't make decisions for yourself you should plan ahead and notate that and have the document(s) notarized so that you will be able to make decisions for yourself even when you aren't capable of doing so.
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cc2
Mush

Registered: 05/15/10
Posts: 2,611
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: cc2]
#13979329 - 02/17/11 03:11 PM (12 years, 11 months ago) |
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Quote:
Humility said: LOL FACEPALM!
You're the one arguing for someone doing something non-consensually to another person and pretending like it's this "necessary evil" that the world couldn't do without.
are you sure? check just some posts above. I highlighted his good point
Quote:
German Kahuna said: Absolutely. There are several reasons why these tests are a good idea. What if they need to administer some medication or another and there are strong contraindications for certain substances. A few weeks ago here in Germany some porn starlet died during anesthesia while getting a boob job, because she didn't tell the surgeon and the anesthetist that she was taking all sorts of meds.
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Doc_T
Random Dude




Registered: 03/06/09
Posts: 42,395
Loc: Colorado
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Humility]
#13979337 - 02/17/11 03:14 PM (12 years, 11 months ago) |
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Quote:
Humility said: If you want something to be done with you when you can't make decisions for yourself you should plan ahead and notate that and have the document(s) notarized so that you will be able to make decisions for yourself even when you aren't capable of doing so.
And if you are in an emergency room without this paperwork, expect to be tested. It's only prudent.
-------------------- You make it all possible. Doesn't it feel good?
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Humility
Working on it



Registered: 10/07/08
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Doc_T]
#13979539 - 02/17/11 03:50 PM (12 years, 11 months ago) |
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You think you're educating me Doc_T? I'm well aware of the nature of your profession and the "authority" you folk assume while "doing your jobs".
Good thing you're just "protecting and serving" huh?
The default is not action, the default is inaction.
If I get into an accident on my motorcycle and I'm lying by the side of the road and have incurred some kind of neck or spinal damage and you move me with good intentions but the results of your actions further damage my body, are you responsible? Did you have any right to move me in the first place? How do you know that that's what I wanted? It doesn't matter, is your response. You're only trying to help is your response.
Responsibility, culpability. These are words that many people don't take seriously any more.
The default is inaction; not action.
Testing someone, that's unconscious, without their consent, is a violation of their fundamental human rights. You don't have the right to draw someone's blood, or connect them to a catheter or do anything to their body without their consent.
It isn't that difficult of a concept to grasp. What's difficult is its application and the fact that it is current an unrecognized axiom.
People do things to people all the time without their consent and no one cares, both because it's the law and because many people simply don't hold human rights in that high of a regard until theirs have been violated.
That doesn't change the situation; it's only another variable to be considered. I find it an extraneous one. You, however, seem to be keen on equating de jure with de facto.
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Doc_T
Random Dude




Registered: 03/06/09
Posts: 42,395
Loc: Colorado
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Humility]
#13979559 - 02/17/11 03:53 PM (12 years, 11 months ago) |
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Nah, I'm just commenting on the thread.
Quote:
Testing someone, that's unconscious, without their consent, is a violation of their fundamental human rights.
Disagree. Testing a random stranger, maybe. Testing an unconscious ER patient? Mandatory.
If you don't want to be tested, or resuscitated, or whatever, have your paperwork in order. Otherwise if you have no papers, you get tested, shocked, anything the doctor says.
To do otherwise would violate basic standards of human decency. If I don't know whether you're a DNR, I'll start thumping.
-------------------- You make it all possible. Doesn't it feel good?
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Humility
Working on it



Registered: 10/07/08
Posts: 6,745
Last seen: 6 years, 11 months
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Doc_T]
#13979618 - 02/17/11 04:00 PM (12 years, 11 months ago) |
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Quote:
To do otherwise would violate basic standards of human decency.
Axiomatic break-down.
I believe the exact opposite. I don't think it's ever right to directly (physically) do anything for or to anyone without their consent.
You disagree.
I accept that.
Don't let me catch you doing something non-consensual to me. I might get non-consensual in return .
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Uzziel
O_o


Registered: 12/30/10
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Re: Why Emergency Docs Test for Illegal Drugs Without Patient Consent Read more: http://www.time.com/ti [Re: Humility]
#13979698 - 02/17/11 04:13 PM (12 years, 11 months ago) |
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I don't see why you're so worried. They only test you so they don't end up killing you on accident. There is a doctor-patient confidentitiality anyway, so you have nothing to worry about...hopefully
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