Edit: Here’s a link to what is most likely the real manifesto: https://www.kenklippenstein.com/p/luigis-manifesto
Ken Klippenstein is a very reliable journalist and this version of the manifesto contains the snippets that have been released by law enforcement. Also, considering the thing was hand-written, that very long version involving his mom is dubious. (And there’s not any good evidence that his mom is in anything besides decent/good health)
You have to make a report if the patient expresses homicidal ideation, intent, and a plan with a specific target or targets in mind. If the target is a particular person (like a partner or friend) you are supposed to notify that person directly or ensure that the police notify them.
Establishing any kind of precedent that chronic pain = homicidal ideation and intent is an extremely bad idea, and not something I’m even willing to joke about.
Yeah I get it, as a doctor your professional rep is on the line, inserting casual threats to insurance execs is not something to do (unless you can somehow organize it across a large group to keep insurers’ feet to the fire).
For me, it’s not the professional reputation, but the second that kind of thing gets tagged onto a patient’s chart, it becomes extremely hard to expunge. There are a lot of patients with mental illnesses (some which are misdiagnoses) that face significant problems because of that diagnosis. If a chart gets flagged with “homicidal ideation” at any point, that patient will forever be flagged as dangerous and people will be suspicious of them immediately.