Recently I heard about a patient who was involved in a motor vehicle accident. He suffered a major pelvic injury and required surgery to fix his pelvis. His only other medical history was that he suffered from significant anxiety and panic disorder.

A few days after his surgery he became very agitated and was apparently found in his room on his feet. The problem was that his surgeon instructed him to not bear weight on his affected side. Thus, the patient was probably affecting the surgical repair when he was up on his feet.

Apparently, the patient demanded to leave the hospital and did not want to be held captive. He was given anti-manic medications by the psychiatry team and they were able to get him to calm down and go to sleep with these medications.

It’s not uncommon for patients with mental illness to have other health problems that are caused by or worsened by mental illness. From the surgical perspective it is very important that patients adhere to post-operative regimens. When they do not, often their surgical repair fails and they blame the surgeon. The statistics of the surgeon reflect a failed outcome and this is bad for the surgeon.

At what point should physicians intervene with aggressive medications to ensure that post-surgical mental illness exacerbations are controlled? In this instance, sedating the patient was probably the correct thing to do. However, at what point are you taking away a patient’s right to not adhere to a post-operative regimen?

I don’t know the answer to this, but it seems like an argument could be made that every patient has a right to disobey his physician’s or surgeons medical advice. As physicians we must strive to do what is right for the patient but we cannot cross over the boundary and take away a patient’s autonomy.

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