Psychiatrists are medical doctors who carry the same kind of medical malpractice insurance as surgeons, family practitioners, etc. The same applies to locum tenens psychiatrists. Yet there is a profound difference between psychiatry and every other form of medicine: psychiatrists deal with mental issues as a specialty. This opens them up to all sorts of ethics questions.
Medical ethics take on a whole new meaning when you are talking psychiatry. Rightfully so, by the way. Where an emergency medicine doctor can treat a broken arm without straying into a whole variety of potential ethical problems, the psychiatrist faces ethical conundrums in every single session.
Fortunately, there are a few common mistakes that, if avoided, can mitigate the risks of ethical violations. Below are just a few of them. The locum, employee, and private practice owner alike would do well to avoid ethical questions by always keeping things on the up and up.
1. Not Respecting Patient Autonomy
This first mistake is one that is prevalent throughout medicine: failing to respect patient autonomy. Doctors tend to expect their patients to believe everything they say and agree with recommendations they offer. Some take patient disagreement as a personal affront.
Patients are not robots. Moreover, they do not always agree with what their doctors say. That is their right. So rather than attempting to manipulate or force patients into certain ways of behaving, a doctor is better off respecting patient autonomy and allowing the individual to make his or her own choices.
2. Not Respecting Patient Confidentiality
The doctor-patient relationship is one that is based on both confidentiality and mutual trust. As such, doctors have an ethical responsibility to protect confidentiality at any cost. That says nothing of their legal responsibilities.
The psychiatrist has to be very careful about disclosing patient information of any kind. If they are legally required to disclose information for one reason or another, then only what is required should be disclosed. Disclosures not mandated by law have to be carefully analyzed according to benefit, purpose, etc.
3. Not Respecting the Multiple Relationship Principle
The psychiatrist may face a conundrum when professional and personal lives intersect. For example, what does a psychiatrist do if he takes on a new patient only discover that the patient’s child and his own play on the same soccer team? Is there a chance the two will meet at a game? Absolutely.
Psychiatrists follow what is known as the multiple relationship principle. Though it is not ironclad, it does go a long way toward avoiding ethics problems by accounting for the duration of the secondary relationship, irrespective of whether that relationship leads to the doctor exercising greater level of control, and the eventual termination of said relationship.
4. Failing to Properly Document
In the event a doctor does face ethical questions, documentation becomes the strongest form of evidence in support of his or her innocence. As such, psychiatrists should be documenting everything about each therapeutic session. Documents should be as thorough as possible without getting into areas that are not relevant to treatment.
Documentation should include history, risk factors, dates and times of service, treatments offered, diagnoses made, and anything else germane to an accepted standard of care. Thorough documentation is a psychiatrist’s best friend when ethics questions arise.
Not avoiding the mistakes listed above can lead to big trouble down the road. The locum could lose his or her ability to get future contracts. The employed doctor could lose his or her job. The private practice owner could see a steady loss of patients. So yes, ethics are important.