Ethical Question Concerning Patient-Physician Relations

When I was shadowing a physician he told me an interesting story about a patient that brings up some ethical questions for patient-physician relations. I thought I would share this story with you all to see some different opinions on how to handle the situation. The physician had told me about this patient who has been a patient of his for many years and was a relatively well-known figure in the community. The physician then told me about the visit he had with the patient two months prior. 

The patient had made an appointment in order to assess a knee that was causing pain and discomfort. The patient arrived at the clinic (a relatively small orthopedic clinic) with a partner. Both the patient and the patient’s partner were clearly very intoxicated. The physician told me that he did his assessment on the knee and had a couple of options for the patient. One of the options included a knee scope surgery and the other was the use of steroid injections in the knee. The physician said he had discussed these options with the patient and the patient was persistent in going through with the surgery. Even though the physician agreed with this patient’s decision, the physician did not feel comfortable scheduling the surgery due to the patient’s state during the appointment. Do you agree with this decision? 

So what the physician did was schedule another clinic appointment with the patient two weeks later to discuss knee treatment options again. I had the opportunity to shadow the physician on the day of this patient’s two-week follow-up. During this appointment, I noticed some unusual behavior in the patient but did not think anything of it since it was my first encounter with this patient. The patient and physician were able to discuss the treatment options again and the patient stated that there was no memory of this discussion in the prior visit. The patient was again very persistent with the physician about getting the knee surgery done so the physician respected the patient’s autonomy and proceeded with the following steps to schedule surgery. After the patient left, the physician had a discussion with me and explained that he noticed out of the ordinary behavior in the patient and suspected that the patient was on some sort of drug. The physician told me that he would need to discuss this situation with his peers. A situation like this puts the physician in a difficult situation with lots of factors to consider. As a physician what would your next steps be in a situation like this?