A Cry for Help: a Case Report of Suicidal Ideation in a Physician-mediated Forum
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Abstract
Background: Forumclinic is a public health engagement program from the Hospital Clinic de Barcelona for chronic disease-interested consumers. Aimed at improving information access in Spanish and Catalan, Forumclinic’s web portal provides a variety of patient resources, including physician-specialist moderated forums and educational videos. Currently, this portal incorporates resources for ten chronic diseases: schizophrenia, diabetes, chronic obstructive pulmonary disease, angina, breast cancer, depression, bipolar disorder, arthrosclerosis, obesity, cardiac risk factors. Since its inception in 2007, there have been three clinical cases that have emphasized the need to examine the ethical and legal obligations of clinicians and service providers in similar situations. What are the ethical and legal responsibilities of service providers when suicidal ideation is exposed? How should forum moderators respond with a limited amount of user information? What is the best risk mitigation strategy for similar situations?
Objective: This presentation is structured in two parts. First a clinical case of a suicidal-valediction patient will set the context of the problem. This will be followed by a review of service provider and clinician’s ethical and legal obligations for similar situations.
Case Presentation: A 29-year-old Hispanic male with schizophrenia reported a failed attempted suicide. After swallowing a number of pills, he was found by his family and transported to hospital. Upon discharge, he presented to the forum requesting advice on the most effective suicidal dose of easily accessible medication. The forum community immediately responded in an empathetic manner and coached the patient to seek medical attention. By the time the forum moderator was informed, the advice given by the Schizophrenia forum community was so comprehensive that the forum moderator had relatively little to add.
Review: According to Ferguson and Eysenbach, clinical interactions through electronic media are classified according to the absence or presence of a bona fide patient-physician relationship. Although it may be argued that forums can create legitimate patient-physician relationships, a comprehensive use of clinician and patient education, disclaimers, and police and patient contact have proven useful for Forumclinic in ethically- and legally-challenging situations.
Conclusions: Clinician-moderated forums are legitimate and challenging spaces for patient engagement. The case presented reveals some of the many ethical and legal challenges that may arise in physician-specialist moderated forums. Although the approach presented here has proven to be useful in cases of suicidal valediction, further research is required in order to establish a series of best-practice guidelines for similar situations. At present, the resilience of the current approach will be tested as litigation arises.
Objective: This presentation is structured in two parts. First a clinical case of a suicidal-valediction patient will set the context of the problem. This will be followed by a review of service provider and clinician’s ethical and legal obligations for similar situations.
Case Presentation: A 29-year-old Hispanic male with schizophrenia reported a failed attempted suicide. After swallowing a number of pills, he was found by his family and transported to hospital. Upon discharge, he presented to the forum requesting advice on the most effective suicidal dose of easily accessible medication. The forum community immediately responded in an empathetic manner and coached the patient to seek medical attention. By the time the forum moderator was informed, the advice given by the Schizophrenia forum community was so comprehensive that the forum moderator had relatively little to add.
Review: According to Ferguson and Eysenbach, clinical interactions through electronic media are classified according to the absence or presence of a bona fide patient-physician relationship. Although it may be argued that forums can create legitimate patient-physician relationships, a comprehensive use of clinician and patient education, disclaimers, and police and patient contact have proven useful for Forumclinic in ethically- and legally-challenging situations.
Conclusions: Clinician-moderated forums are legitimate and challenging spaces for patient engagement. The case presented reveals some of the many ethical and legal challenges that may arise in physician-specialist moderated forums. Although the approach presented here has proven to be useful in cases of suicidal valediction, further research is required in order to establish a series of best-practice guidelines for similar situations. At present, the resilience of the current approach will be tested as litigation arises.
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