Your patient is a 45-year-old male with a history of bipolar disorder. He is sitting at the kitchen table, conscious, alert, and oriented. He is pleasant and greets you as you walk in. The patient's wife called EMS because he has refused to take his lithium and is "driving her crazy with his hyperactive attitude." She insists that you transport him to the hospital. The patient admits to voluntary noncompliance with his lithium, stating "I didn't like the way it made me feel." He denies any suicidal thoughts and states that he has not felt "this good for a long time." He is curious about your job and wants to know how he could get into a paramedic class. He states that he's also thinking about going to law school but wants to finish his PhD first. The physical examination is unremarkable, and HR = 82, BP = 122/80, RR = 10, SaO2 = 99%. He says, "See, I told you I'm fine. I don't need to go to the hospital." Which of the following is the best course of action?
A) Restrain the patient if necessary and transport.
B) Explain to the wife that you cannot force the patient to go to the hospital and that if he refuses you must have him sign a refusal of service form and leave.
C) Request police backup, restrain the patient, and transport to the ED for evaluation.
D) Explain to the patient that he has no choice. If he is unwilling to take his medication, you must take him to the hospital for evaluation.
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