Magazine article Clinical Psychiatry News

Courts Frown on MDs Who Just Manage Meds

Magazine article Clinical Psychiatry News

Courts Frown on MDs Who Just Manage Meds

Article excerpt

TUCSON, ARIZ. -- When managed care rules interfere with good care, psychiatrists suffer the consequences in court, Dr. Barry M. Morenz cautioned colleagues at a psychopharmacology conference sponsored by the University of Arizona.

Dr. Morenz, a faculty member of the University of Arizona psychiatry department who has a special interest in medicolegal issues, said psychiatrists are losing both malpractice cases and their licenses when bad outcomes occur in patients they don't know or don't know well.

The problem tends to arise when psychiatrists are reimbursed only for the briefest of visits to adjust medication dosages.

The patient may see a counselor more regularly, but the psychiatrist is often the practitioner held liable for how the patient ultimately fares.

"This is a real dilemma," he said. "How can you know patients when you see them for 15 minutes every 4 months?"

Dr. Morenz advised colleagues to resist the pressure to shorten intake interviews to 15 minutes, since a thorough familiarity with a patient and his or her history requires significantly more time than that. Taking time to build a legitimate doctor-patient relationship not only enhances one's job satisfaction but also diminishes the malpractice risk, he stressed.

No patient should feel that the psychiatrist's only role is to do an "anonymous 6-month review of medications."

Dr. Morenz also alerted psychiatrists not to feel too secure about the protection of patient consent forms, which he said are "easily dismissed in court." Patients or family members later say they didn't understand or didn't read such forms.

A better way to document patient consent is to write a short note in the patient's chart saying that a discussion was held and that the patient had questions. Write down each question and how you answered it, Dr. …

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