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Forensics & Ethics

Vignette Answers

Jack Krasuski, MD

American Physician Institute

for Advanced Professional Studies

DrJack@AmericanPhysician.com

Module: Vignette

| Missed Appointments Laura is a 23 y.o. female in treatment with

you and a therapist for depression, anxiety

and alcohol abuse. She appears to have a

chaotic emotional, social, and career life.

She has a history of three suicide attempts.

One was medically serious

She has missed her last three appointments.

She called after the first two times to

apologize and reschedule. She has not

called after missing the last appointment 2

Vignette MCQ 1: Which of the following

items, that if included in your treatment

contract, could now best guide your next

clinical steps? (Choose 3)

A. No show policy

B. Second opinion policy

C. Circumstances under which emergency

contact would be called

D. Payment policy

E. Informed consent policy 3

Vignette MCQ 2: Which is the most

pertinent medical-legal issue confronting

you as you debate whether or not to

terminate Laura’s treatment? (Choose 1)

A. Avoiding patient abandonment

B. Her right to a second opinion

C. Maintaining her confidentiality

D. Confirming her capacity to provide

informed consent

E. Ensuring that patient’s decision is not

made under duress 4

Vignette MCQ 3: Which of the

following would you like to do before

terminating Laura from your treatment?

(Choose 3)

A. Ensure she is not in a crisis currently

B. Avoid follow up contact with her whose purpose

would be to ensure she established contact with

a new provider

C. Provide her with names of alternate clinicians

D. Review terms of the treatment contract with her

5

Vignette MCQ 4: Laura receives a treatment

termination letter from you. She calls you

leaving a distressed message stating she will

kill herself and make sure the “whole world”

knows it was your fault. She sounds

intoxicated. What are you most likely next

clinical steps? (Choose 2)

A. Call the police for a well person check

B. Drive out to her apartment to check on her

C. Call her emergency contact to check on her

D. Ignore her manipulative message 6

The End