Pediatric hospitalists face many patients with diagnostic and therapeutic uncertainty. Confronted with this issue, they may question their obligation to continue treatment plans they do not agree with or are not comfortable providing. Additionally, hospitalists manage an increasing number of patients with psychiatric disease, as the lack of intensive psychiatric services has placed a greater burden of behavioral problems on inpatient care wards. We offer the following case to consider the ethical obligations of the hospitalist to continue an outside provider’s treatment plan and how to provide the best care of complicated psychiatric patients without a disposition.

An adolescent young man presents to the emergency department after ingestion of a nontoxic household product. He is admitted to the hospitalist service due to continued decline of executive functions, increased self-neglect, and increase in bizarre behaviors. His past medical history is significant for receptor-negative autoimmune encephalitis diagnosed 2 years before presentation.


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