Citation

Fishalow SE. Bull. Am. Acad. Psychiatry Law 1975; 3(4): 191-230.

Copyright

(Copyright © 1975, American Academy of Psychiatry and the Law)

DOI

unavailable

PMID

1234518

Abstract

It is indisputable that claims against psychiatrists are now reaching a new level of significance. Verdicts are being returned against more defendants, in a widening circle of liability, and for amounts which are ever increasing. The following caveats should be observed by all psychiatrists: 1. Diagnosis The psychiatrist must act with that degree of skill and care common to others in his specialty when diagnosing a patient. The diagnosis should be periodically reviewed. 2. Shock therapies a. The psychiatrist must obtain informed consent before proceeding. If the patient is incapable of consent for any reason, efforts should be made to communicate with a close relative or guardian. b. Proper premedication must be administered. c. Equipment and personnel to handle cardiorespiratory emergencies must be immediately available. d. Diligent care and observation must be supplied for a reasonable period of time after the treatment. 3. Drug therapy a. The psychiatrist must obtain informed consent (see 2-a above). b. Close attention should be paid to the manufacturer's package insert. c. Extreme caution must be observed in prescribing dangerous drugs for a potentially suicidal patient. 4. Suicides Reasonable skill and diligence must be applied a. to determine the likelihood of a patient's committing suicide, and b. to protect the patient once suicidal tendencies have been diagnosed. 5. Injuries to third parties The same considerations apply as were noted in "Suicides." 6. Confidentiality: duty to warn a. Before making any disclosures as to the mental state of his patient, a psychiatrist should be certain that he is protected by privilege (e.g., judicial immunity) or by the prior consent of the patient. b. However, Tarasoff (supra, p. 210 ff.) may impose on the psychiatrist an affirmative duty to warn a party whose life or safety has been threatened in a disclosure to the psychiatrist. Competing interests must be carefully balanced. 7. Commitment The psychiatrist must exercise due care and diligence in examining patients for commitment proceedings, taking care to see that there is probable cause. 8. Psychotherapy a. In addition to ordinary care and skill, the psychiatrist owes his patient the duty of maintaining the trust established in the therapist-patient relationship. b. The psychiatrist bears the burden of establishing the justification of any innovative therapy, particularly should he become sexually or socially involved with the patient. While adherence to the above admonitions will not guarantee verdicts for defendant psychiatrists, it will hopefully reduce the professional, financial, and emotional costs of litigation.

Language: en