ABSTRACT
Suicide is difficult to predict, has the potential for catastrophic outcome, and is preventable. Although some persons admit freely to feelings of sadness and wishes for their lives to be over, others offer little, if any, overt forecasting of impending self-harm. Many of these same people seek help under other auspices. Approximately two thirds of those who commit suicide had visited a physician during the preceding month. Recognizing the signs and symptoms with which suicide-prone patients present to emergency departments is central to preventing unnecessary death, injury, and disability caused by failed attempts. The common presentations of patients at risk for suicide and some of the psychiatric conditions that carry a risk for suicide are reviewed.
Subject(s)
Depressive Disorder/diagnosis , Suicide , Bipolar Disorder/diagnosis , Borderline Personality Disorder/diagnosis , Depressive Disorder/complications , Diagnosis, Differential , Humans , Male , Middle Aged , Panic Disorder/diagnosis , Risk FactorsABSTRACT
When healthcare coverage entails medical necessity review, patients, providers, payers, and government agencies must confront issues of fairness and rationing. To explore the ethical ramifications of medical necessity decisions, we provide 2 illustrative case. In the first case, we discuss the implications of rule-based rationing and in the second we consider the influence of a medical group's internal review council on decisions of medical necessity. Both case examples illustrate why there are no agreed-on rules for setting a threshold for approving or denying care based on medical necessity and suggest that more complex medical cases require a more complex review process.
