How Legaly Involved is Psychiatry?

[Leukocyte]

I was just wondering, how litigious is the everyday practice of outpatient/inpatient psychiatry? If you ask me, a non-psychiatrist, I would assume psychiatric practice to be an extremely litigious career given the often contentious, and even hostile, nature of some patient interactions....I mean, one can easily imagine how paranoid patients can simply falsely accuse their psychiatrist for doing something wrong!!!

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Thanks

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[SuperSoccer19]

I was just wondering, how litigious is the everyday practice of outpatient/inpatient psychiatry? If you ask me, a non-psychiatrist, I would assume psychiatric practice to be an extremely litigious career given the often contentious, and even hostile, nature of some patient interactions....I mean, one can easily imagine how paranoid patients can simply falsely accuse their psychiatrist for doing something wrong!!!

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Thanks

I practice in the military, so my answers are probably way different. Personally, I have more problems with my antisocial and axis II patients, but here goes...

-I don't think I've had a psychotic or manic patient NOT accuse me of this. Most have a lack of insight and they do not understand why they cannot be in the military anymore. They often ask for second opinions, fight their discharges and their parents/spouses also seem to have significant denial. Often their family members go through a phase where they blame us for what happened or at least displace blame for some reason. None have actually followed through on their claims to sue in my case. I also don't really think I can be sued. This also applies to the axis IIs that I see. They like to recreate the past and there's often a significant amount of poetic license.

-Not really--I have done an insanity board before, but I did not have to talk about it in court--I was a resident at the time and my attending had to speak of it, but he was a forensic psychiatrist. Have had coworkers serve as witnesses for drug charges, malingering, etc., but I never have.

-Not really afraid, but it is realistic--more for other claims though. The psychotic patients I know others will probably agree with my diagnosis. Its the cluster b's that lead to more concern again. Just need to document and if its a tough case where I see this *might* happen, get others involved early. I did have a coworker once get in trouble for breaching patient confidentiality in a demented patient, but the thing is that the military allows this, but the civilian world doesn't so this created confusion.

For me there are a lot of legal things that come up since I *may* report UCMJ violations to commands, our standards for detaining both active duty and civilians are weird and there are a lot of things I do that JAG needs to get involved with. For example, if I want to kick someone out or if a command requests a non-voluntary psych eval or something, these are legal issues.

Just out of curiousity, what is your interest in this?

 

[michaelrack]

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

Paranoid patients make accusations all the time, but nothing comes of it because they usually don't have a lot of cash and lawyers know they aren't going to make any money if they file a case based on a delusion.

 

[michaelrack]

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?


Thanks

Not usually, although it varies from state to state. Psychiatrists will sometimes have to go to court for a committment hearing (not typically for a simple hold).

In WV, a judge and attorney come to the inpt ward/er for a hearing on involuntary holds (at least they did 10-15 years ago when I was a resident )

In some states a designated psychiatrist or psychologist at the regional community mental health center will do a lot of the legal work (committments, court evals). Some states have a forensic unit at the state hospital.

If you don't want to get involved with the courts, you typically won't have to after psych residency

 

[dl2dp2]

I was just wondering, how litigious is the everyday practice of outpatient/inpatient psychiatry?

Statistically, psychiatrists are amongst the LEAST likely to be sued for malpractice in all of medicine. Malpractice insurance, therefore, is also the least expensive. This is an important factor in making the specialty very friendly for part time private practice arrangements.

 

[peppy]

Just out of curiousity, what is your interest in this?

From his other posts, it sounds like he's thinking about trying to switch into Psych.

 

[TexasPhysician]

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Thanks

Pulled into courts? Some psych docs get paid quite well to testify in court

Think about your question for a moment. You have a paranoid or delusional or psychotic patient who is angry. First they call attorneys. The patient has to be reasonable enough that the story seems believable or the attorneys tells them to seek help. This eliminates maybe 50+%. Even if believable, the attorney only continues to listen if the case appears to have a possibility of having caused severe harm or involves severe misconduct. Malpractice cases cost too much money, so it needs to be an easily proved case as well. This eliminates another 49+%. Even if anything goes to trial, the lay-person (with geographical fluctuations) often perceives psychiatrists as dealing with "crazy" people. Some of my most stable patients even admit they have thought themselves "crazy" at times. A jury is less likely to believe the prosecution for this reason. Not to mention many of these patients are on a psych ward with plenty of staff witnesses.

Other than a few controversial issues (antipsychotics with dementia), there are few malpractice claims that get anywhere in psychiatry. This is part of the reason our rates are so low.

 

[Craigz]

If each patient who thought they were being mistreated could successfully sue the psychiatrist, that would have been a nightmare. The downside of that, of course, is that some incompetent psychiatrists do get away with harming the patients. It would be easier to assign blame if the evidence for mistakes were physical, like a surgeon who didn't properly suture a wound. But I think the nature of mental health issues is such that whether you do good or bad, it's harder to prove your responsibility for it.

 

[BobA]

I was just wondering, how litigious is the everyday practice of outpatient/inpatient psychiatry? If you ask me, a non-psychiatrist, I would assume psychiatric practice to be an extremely litigious career given the often contentious, and even hostile, nature of some patient interactions....I mean, one can easily imagine how paranoid patients can simply falsely accuse their psychiatrist for doing something wrong!!!

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Thanks

Look Here:
http://www.nejm.org/doi/full/10.1056/NEJMsa1012370

Malpractice Risk According to Physician Specialty

Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D.

N Engl J Med 2011; 365:629-636August 18, 2011DOI: 10.1056/NEJMsa1012370

 

[Leukocyte]

Just out of curiousity, what is your interest in this?

As peppy mentioned, I am considering swiching into psychiatry.

I like the field and I am very interested in the pathophysiology of mental illness and the significance of its control and treatment on the patients' quality of life,....... but I am worried about the potential "occupational hazard" to the Psychiatrist that can come from dealing with such a volitile and unpredictable patient population.

I also wanted to know how stressful the average daily practice is. I an aware of that NEJM study, and understand that the study showed that Psychiatry had a low prevalence of malpractice lawsuits, but does this accurately reflect the reality for most psychiatrists....and even if it does, it does not reflect the other legal matters (non-malpractice legal matters) that psychiatrists might have to deal with, for example:

-Work stress from contantly having to explain the reasoning behind an involuntary admission, mental capacity evaluation result, ect.......

-Work stress from the fear of being falsely accused...For example, I heard that many Psych. docs are reluctant to give an order to restrain an aggitated patient, when a nurse calls them for it.

-Stress from going through the mandatory investigation after a false accusation. I have heard that ALL accusations (even if false) have to be investigated by the hospital. Even though the Psychiatrist is innocent and did nothing wrong, the stress from having to go through these investigations for every false accusation can be extremly stressful.

-Stress from the potential for false reports to the medical boards...Boards have to investigate ANY claim, even if false, and that can be extremly stressful too.

For an outsider, like myself, it seems that the field can be very stressful and full of potential occupational hazards (as mentioned above)....is this really so?

Thank you all

 

[birchswing]

People with mental illness do exist in the world outside of a psychiatrist's office. It's not as if psychiatrists are unique in interacting with people who have mental illness. People with mental illness also see general practitioners, dentists, hairdressers. They go to restaurants. They live with families, who sometimes are also caretakers for them. I suppose psychiatry is unique in that while in a psychiatrist's office, you're aware that people are there specifically for the purpose of diagnosing or treating a mental illness, but the interesting thing is that when you start talking to people in almost any random environment, you'll find out how common diagnosed mental illnesses are, along with psychiatric medication usage, or symptoms of mental illness.

This is a very obvious thing to say, and maybe shouldn't be pointed out for that reason, but sometimes the conversations on these boards seem to sort of take the population and both make it sound like psychiatric illness is the last word on a person's life and also that no one else meets with people with mental illness.

Think of people who work in bars and diners. Flight attendants. They deal with people in disorganized states of mind all the time.

As far as false accusation, I think it was discussed on this board before, and there was somewhat of a consensus that not enough is done on behalf of the patients in cases of patient complaints, and that if there are illegitimate complaints, they're more of a pain in terms of paperwork for the practitioner than anything else. Where I live there is a psychiatrist who is known as the guy who hands out anything a patient asks for. Another is known as a cult leader (not kidding, as much as I've not been believed when mentioning this before). And as much as other professionals encourage patients to report them, I've never even seen a sanction against them appear on their state profiles.

 

[Leukocyte]

Paranoid patients make accusations all the time, but nothing comes of it because they usually don't have a lot of cash and lawyers know they aren't going to make any money if they file a case based on a delusion.

Whether something comes out of it or not is irrelevant...The outcome of a false accusation is not important because the damage to the physician has already been done by simply accusing her/him.

How do Psychiatrists deal with the stress of a false accusation investigation? How are you guys able to function emotionaly after such a horrible and unfair experience?

 

[PrideNeverDie]

Whether something comes out of it or not is irrelevant...The outcome of a false accusation is not important because the damage to the physician has already been done by simply accusing her/him.

How do Psychiatrists deal with the stress of a false accusation investigation? How are you guys able to function emotionaly after such a horrible and unfair experience?

psychiatrists are the least sued doctors.

you treat false accusations like you treat a woman's comments when she is upset.
you disregard it as irrelevant like a man.

 

[hamstergang]

Whether something comes out of it or not is irrelevant...The outcome of a false accusation is not important because the damage to the physician has already been done by simply accusing her/him.

Depends who the accusation is made to. The point that was being made is that the patients very rarely do it officially, so it ends up not mattering at all. When they're really sick, I've seen a good number of patients threaten to sue, but they think differently once they clear up.

For an outsider, like myself, it seems that the field can be very stressful

Did you do a psych rotation in med school? Did the psychiatrists seemed stressed to you?

 

[BobA]

Psychiatry is pretty broad, and I think a lot will depend on the psychiatrist's personality as well as the practice setting.

One of the more common reasons psychiatrists get sued is for sleeping with their patients, which is entirely avoidable.

Other things psychiatrists gets sued for are med side effects, for which you can document risk benefit discussion.

Psychiatrists can also get sued if a patient commits suicide or homicide but since there's not much we can do to predict these things (try as we might) it's hard to hold a psychiatrist responsible for that. We just need to show through documentation that we are providing standard of care.

But if you want to know how much we worry about being sued - that's going to depend on the specific person and their practice setting.

 

[michaelrack]

psychiatrists are the least sued doctors.

you treat false accusations like you treat a woman's comments when she is upset.
you disregard it as irrelevant like a man.

exactly. The accusations of psychotic patients usually aren't taken seriously and there is usually no investigation.

----------------------------------------------

There is one type of accusation that can get a psychiatrist in trouble: a sexual accusation, although it depends on the circumstances. An accusation from a reasonably attractive non-psychotic outpatient is much more serious than an obviously false accusation from a schizophrenic 400 lb inpatient.

Bottom line: make sure you are never alone with a female patient (have the door open in line of sight of a secretary, etc) and you should be fine. Of course, it goes without saying, don't ever sleep with a patient.

 

[dl2dp2]

Bottom line: make sure you are never alone with a female patient (have the door open in line of sight of a secretary, etc) and you should be fine. Of course, it goes without saying, don't ever sleep with a patient.

Really? But I always close the door when talking the patient. Also, I don't see how this can be done in a therapy situation.

 

[BobA]

As peppy mentioned, I am considering swiching into psychiatry.

I like the field and I am very interested in the pathophysiology of mental illness and the significance of its control and treatment on the patients' quality of life,....... but I am worried about the potential "occupational hazard" to the Psychiatrist that can come from dealing with such a volitile and unpredictable patient population.

I also wanted to know how stressful the average daily practice is. I an aware of that NEJM study, and understand that the study showed that Psychiatry had a low prevalence of malpractice lawsuits, but does this accurately reflect the reality for most psychiatrists....and even if it does, it does not reflect the other legal matters (non-malpractice legal matters) that psychiatrists might have to deal with, for example:

-Work stress from contantly having to explain the reasoning behind an involuntary admission, mental capacity evaluation result, ect.......

-Work stress from the fear of being falsely accused...For example, I heard that many Psych. docs are reluctant to give an order to restrain an aggitated patient, when a nurse calls them for it.

-Stress from going through the mandatory investigation after a false accusation. I have heard that ALL accusations (even if false) have to be investigated by the hospital. Even though the Psychiatrist is innocent and did nothing wrong, the stress from having to go through these investigations for every false accusation can be extremly stressful.

-Stress from the potential for false reports to the medical boards...Boards have to investigate ANY claim, even if false, and that can be extremly stressful too.

For an outsider, like myself, it seems that the field can be very stressful and full of potential occupational hazards (as mentioned above)....is this really so?

Thank you all

I do not find psychiatry to be stressful.

During the first three years of residency it was at times stressful dealing with patients who I didn't know how to deal with yet -patients with personality disorders, and substance abuse.

However, I've learned during my residency how to manage interactions with difficult patients and I no longer find them very stressful. If you do switch, I recommend a program with strong training in psychotherapy.

I don't worry too much about being sued. Fear of being sued does make me document a little more thoroughly than I might otherwise, but it doesn't affect me day to day.

 

[Leukocyte]

Thank you all for your insight. As a FM doc, I see my fair share of mild mood disorder patients, and the encounters are much less stressful than the 90 YO patient with a dozen medical problems and 15+ different medications. That is one of the reasons why I am thinking of doing a third residency, in psychiatry. I have always felt comfortable treating my psych patients, I am very good at it, and I enjoy the pathophsyiology of psych disorders.

you treat false accusations like you treat a woman's comments when she is upset.

LOL. Just a friendly advise from an old-timer (if you cosider 36 old): One should NEVER EVER EVER under-estimate a woman's, ANY woman's, comment while she is upset. Yes, she might calm down later, but her damage might have already been done. Do not let the hot, cute, innocent, cuddly, puppy eyes of a woman fool you. They are MUCH more powerful than they may seem.

Did you do a psych rotation in med school? Did the psychiatrists seemed stressed to you?

No, they were the most relaxed. But as we all know, a 6 week med school rotation, experience means nothing at all. Hell, even residency experience does not completely reflect the true real-life experience of an attending (I learnt that the hard way after my FM residency). The best I could do at this time is to get the points of view of as many Psychiatrits as I can before plunging into a third residency...and an annonymous forum like this is great since the incentive for a response bias is minimal.

Thank you all for your great input.

 

[notdeadyet]

-Work stress from contantly having to explain the reasoning behind an involuntary admission, mental capacity evaluation result, ect.......

Not stressful. Many folks who are put under involuntary admission are so disorganized, fearful, suicidal, etc. that they don't have a great command of what's going on anyway. You're typically doing a service by admitting them. Mental capacity evals are helpful to team members (you're often doing these in a consultative role) and to the patient. ECT is a lifeline for folks failing lots of other modalities.

-Work stress from the fear of being falsely accused...For example, I heard that many Psych. docs are reluctant to give an order to restrain an aggitated patient, when a nurse calls them for it.

Falsely accused happens and can be a little stressful. I was accused of a very deplorable crime by a patient but she was being camera monitored so it was easy to show it was groundless. It happens, but isn't common.

The restraints issue isn't anything to do with accusations. The reason psychiatrists are often reluctant to give orders to restrain and agitated patient is that the patient often doesn't really need restraints every time a nurse things he does.

-Stress from going through the mandatory investigation after a false accusation. I have heard that ALL accusations (even if false) have to be investigated by the hospital. Even though the Psychiatrist is innocent and did nothing wrong, the stress from having to go through these investigations for every false accusation can be extremly stressful.

Yep. I was investigated by the hospital and sheriff's department. These are much more stressful in anticipation than practice. Both investigations were made painfully clear from the outset that everyone involved knew I was innocent (including the patient) but an investigation is necessary so that there is no uncertainty. If it happens again, I'll dread the next one much less for having experienced the first.

-Stress from the potential for false reports to the medical boards...Boards have to investigate ANY claim, even if false, and that can be extremly stressful too.

No experience with this.

For an outsider, like myself, it seems that the field can be very stressful and full of potential occupational hazards (as mentioned above)....is this really so?

Psychiatry is stressful like any job in which you hold responsibility for other people's health and care is stressful. But on the spectrum of stress levels for physicians? I'd put it way on the lower stress end.

That said, I love the job. The most stressful job you'll ever have is the one you don't enjoy.

 

[Craigz]

Since both the issue of how stressful the work is and how often psychiatrists gets sued, has come up, does anyone have a link to data on both ranking job stress in medicine and also how often people in different specialties get sued? If not, what would be your subjective opinion? I once spoke to a neurosurgeon who told me he thinks neurosurgeons get sued most often and not because they're more likely to make mistakes but because they're more likely than, say, GPs, to work on serious cases, when the patient ends up dying or otherwise loses some function after treatment. And people don't like negative results so someone has to be blamed.

 

[Craigz]

Psychiatrists can also get sued if a patient commits suicide or homicide but since there's not much we can do to predict these things (try as we might) it's hard to hold a psychiatrist responsible for that. We just need to show through documentation that we are providing standard of care.

I wonder if the same would apply to other specialties. Needless to say, if a CT surgeon sleeps with a patient, s/he too can get sued successfully. But can they get sued successfully if there are serious adverse results as a result of a surgery, as long as it has been documented that they have provided the standard care?

 

[BobA]

I wonder if the same would apply to other specialties. Needless to say, if a CT surgeon sleeps with a patient, s/he too can get sued successfully. But can they get sued successfully if there are serious adverse results as a result of a surgery, as long as it has been documented that they have provided the standard care?

In order to for a physician to lose a malpractice case the plaintiff must prove that there was negligence, which is practicing below the standard of care.

Thus, I imagine (since I haven't been through one myself) a suit about a patient suicide would focus on whether or not the psychiatrist practiced the standard of care. It might involve issues of ignoring warning signs that the patient should have been hospitalized, or should not have been released from the hospital, etc. As long as the psychiatrist practiced the standard of care and documented this they should be OK.

 

[michaelrack]

Really? But I always close the door when talking the patient. Also, I don't see how this can be done in a therapy situation.

why not? just have the door open a little so the secretary/office asst can see in. Of course, there should be no opportunity for another patient to see in.

An old-school traditional psychotherapist would disagree with my advice.
The old-school traditional psychotherapists are also the ones who tend to sleep with their patients.

 

[vistaril]

why not? just have the door open a little so the secretary/office asst can see in. Of course, there should be no opportunity for another patient to see in.

An old-school traditional psychotherapist would disagree with my advice.
The old-school traditional psychotherapists are also the ones who tend to sleep with their patients.

well most offices are going to be set up such that leaving the door open a little bit isn't going to allow the secretary/office asst to see in. If there is a secretary/office assistant in a practice it is likely going to be a multi-person practice with lcsws, nps, maybe even another psychiatrist or two. I just find it extremely unlikely that the setup would be such that the secretary just happens to be looking in through a cracked door in any outpt office.

The thought would never come to me(except for a patient who is very obviously aggressive and violent) to leave the door open a little during a therapy session or even a med mgt session. It just seems so foreign to all that being a psychiatrist is. I don't think I am alone in saying that I don't think this is ever done(doors cracked open in outpt therapy or med mgt sessions)

 

[michaelrack]

It just seems so foreign to all that being a psychiatrist is. I don't think I am alone in saying that I don't think this is ever done(doors cracked open in outpt therapy or med mgt sessions)

I guess that idea came from the internist part of my brain and not the psychiatrist part

I can see why doing this wouldn't be practical in a residency setting. .

I guess there isn't much point in arguing the matter further. I was going to write more about this topic, but have decided against it.

 

[birchswing]

I've never heard of a psychiatrist or internist or therapist who would leave a door open during session. Most even have white-noise machines outside their door to further protect privacy.

And what is meant by old-school psychotherapist? It's such a generic term, I have no idea what the difference is between an old one and new one, except that apparently the old type slept with their patients (source on that?)!

 

[vistaril]

I guess that idea came from the internist part of my brain and not the psychiatrist part

I can see why doing this wouldn't be practical in a residency setting. .

I guess there isn't much point in arguing the matter further. I was going to write more about this topic, but have decided against it.

I've never done an outpt medicine clinic before, but when you had general medicine clinic and were with a pt(and not during gyn or breast exams or whatever...I get that thats different) would you always have the door open or always have another person in the room? If I were a patient, it would just seem natural to want the door closed. But I've never really thought about things from a medicine clinic standpoint...

 

[michaelrack]

And what is meant by old-school psychotherapist? It's such a generic term, I have no idea what the difference is between an old one and new one, except that apparently the old type slept with their patients (source on that?)!

By old-school, I am referring to psychiatrists who trained in the 60's to 80's and received extensive psychotherapy training, primarily in psychodynamic psychotherapy (as opposed to younger psychiatrists with lesser psychotherapy training, with much of the training they do get being in CBT). And yes, I do know of a few old-school psychiatrists who have done some dark things.

 

[michaelrack]

I've never done an outpt medicine clinic before, but when you had general medicine clinic and were with a pt(and not during gyn or breast exams or whatever...I get that thats different) would you always have the door open or always have another person in the room? If I were a patient, it would just seem natural to want the door closed. But I've never really thought about things from a medicine clinic standpoint...

I concede the point, maybe my practices are a little idiosyncratic. Most of my patients are older, male, and/or come to the appointment with a family member/friend- so it's usually not an issue. In my Tupelo office, it acutally works quite well (because of the physical layout) to have the door cracked a bit for the rare, unaccompanied, younger female patient.

In my Southaven MS office the patient lobby is right by the exam room. There I do leave the door closed (having waiting patients right outside does offer its own protections) and get a chaperone for exams on the rare unaccompanied younger female patient. The female NP sees most of the patients there however, I only do clinic there about 3 half-days per month.

My practice is different than most internists or psychiatrists, so I concede the point. I am a little paranoid, and the way I do things does work out well for my practice.

 

[Ibid]

exactly. The accusations of psychotic patients usually aren't taken seriously and there is usually no investigation.

This is exactly why investigations should take place.
----------------------------------------------

There is one type of accusation that can get a psychiatrist in trouble: a sexual accusation, although it depends on the circumstances. An accusation from a reasonably attractive non-psychotic outpatient is much more serious than an obviously false accusation from a schizophrenic 400 lb inpatient.

The attractiveness or otherwise of the victim is a total irrelevance. Can you imagine a police department deciding to investigate on these sort of grounds...

Either way if the allogation is proved true you are going to prison. Just so you know...you wont get a lighter sentence because the victim was a fatty.

Hopefully just hopefully you will get justice....just so long as the jury isn't as prejudiced. As far as I know they don't hand down convictions based on the alleged victims attractiveness....imagine "yeah....she is really hot...obviously he did it..." luckily the world isn't like this. although i'm willing to believe it is like that in Texas...if you say so...

 

[billypilgrim37]

Either way if the allogation is proved true you are going to prison. Just so you know...you wont get a lighter sentence because the victim was a fatty.

Methinks you misoverestimate the American judicial system, my friend. There is no limit to the misogyny an American jury might affirm, especially in Dr Rack's neck of the woods.

 

[TexasPhysician]

luckily the world isn't like this. although i'm willing to believe it is like that in Texas...if you say so...

Texas women are all attractive. We ship the uglies to NM, OK, and LA. If you've ever been to one of those 3 states, you know what I'm talking about.

 

[vistaril]

Methinks you misoverestimate the American judicial system, my friend. There is no limit to the misogyny an American jury might affirm, especially in Dr Rack's neck of the woods.

Have you lived all over the country? And I don't mean driven through on your way to the beach before....living in many different areas of the country gives one a much more complete perspective imo.

 

[billypilgrim37]

Have you lived all over the country? And I don't mean driven through on your way to the beach before....living in many different areas of the country gives one a much more complete perspective imo.

I'm confused as to what you mean. I've lived close enough to where Dr Rack is to be able to make some jokes about it. I certainly have the accent to prove it.

I've lived in the SEC, the ACC, the Big Ten, and the Big East. No Pac10/12 or Big 12.

I imagine that Conference USA certainly allows for broader geographic considerations.

 

[Leukocyte]

The attractiveness or otherwise of the victim is a total irrelevance.

If one thinks that a sneaky,conniving, very attractive woman cannot get an innocent man in trouble with a few crocodile tears, then obviously they are either not experienced enough in life, or just intentionally refuse to accept reality due to a blind cause (such as the gender extremist who call themselves feminists).....While we try not to, humans go by appearances.....and thinking otherwise is very naive. This is life, not heaven. We are humans, not angles. Stereotypes, racism, and injustice will always be there, no matter how hard we try to stop them. That is reality.

 

[OldPsychDoc]

If one thinks that a sneaky,conniving, very attractive woman cannot get an innocent man in trouble with a few crocodile tears, then obviously they are either not experienced enough in life, or just intentionally refuse to accept reality due to a blind cause (such as the gender extremist who call themselves feminists).....While we try not to, humans go by appearances.....and thinking otherwise is very naive. This is life, not heaven. We are humans, not angles. Stereotypes, racism, and injustice will always be there, no matter how hard we try to stop them. That is reality.

Glad you don't feel the need to be obtuse about it...

 

[Leukocyte]

Thank you all for your posts. Reading the posts, it appears that Psychiatry might not be as litigious as other specialties (which I already knew beforehand from the NEJM study), but it looks like the prcatice of psychiatry, by nature of the profession and the type of care provided, deals with legal aspects of patient care a little more than the other medical specialties. By "other legal aspects" I mean, more papers to fill and decisions to make that have a legal "flavor". No wonder why Psychiatry has a whole fellowship dedicated to such matters (Forensic Psychiatry)!!! But I think a general psychiatrist also deals with these "para-legal" patient issues to a lesser extent. Right?

Thanks again.

 

[Leukocyte]

Glad you don't feel the need to be obtuse about it...

Good catch, you are an Angel!!!

 

[markglt]

looks like i'll be moving to texas

 

[Ibid]

Methinks you misoverestimate the American judicial system, my friend. There is no limit to the misogyny an American jury might affirm, especially in Dr Rack's neck of the woods.

Close enough to home to make jokes about it a judge recently dismissed a jury in a high profile case for "absolutely fundamental deficits in understanding" If i'm not mistaken thats posh legal talk for thick as two short planks.

http://www.independent.ie/irish-new...ses-confused-jury-in-pryce-case-29085006.html

 

[Ibid]

If one thinks that a sneaky,conniving, very attractive woman cannot get an innocent man in trouble with a few crocodile tears, then obviously they are either not experienced enough in life, or just intentionally refuse to accept reality due to a blind cause (such as the gender extremist who call themselves feminists).....While we try not to, humans go by appearances.....and thinking otherwise is very naive. This is life, not heaven. We are humans, not angles. Stereotypes, racism, and injustice will always be there, no matter how hard we try to stop them. That is reality.

Right. Ok. So in your world women who claim to have been abused fall into two groups.

1. Ugly and therefore obviously lying
2. Attractive (on Leukocyte attractive-o-meter) and therefore sneaky and conniving and therefore obviously lying.

Brilliant. Case dismissed.

Does your attractive-o-meter work for cases involving children as well? Or men who claim to have been raped by men? How does your attractive-o-meter swing in these cases??

This bit is going to be shock for you but someone has to tell you. Sometimes women abuse other women. Take a minute to recover.....

Best if you sit down because this is going to blow you away. Those gender extremists are just women. Plain old ordinary women. They only seem extreme to you because you have only just come to terms with the fact that they get to vote and everything.

Anyway....i've taken your name and put you down in my little black book of gender thought criminals. I'm reporting you to Germaine Greer straight away. So expect a knock on the door in the middle of the night from some women. (btw its not what you think....they are going to be pissed off with you so don't even think about trying it on...ok)

 

[pml1224]

Bump.

I was wondering if I could ask the same question as the OP, but with a little bit more detail in relation to sexual misconduct? I know I have a long way to go, but psychiatry is the only rotation I have enjoyed so far. I think the specialty will be the best fit for me. However, I'm concerned about the risks associated with working with psych patients (especially cluster B's). I don't think it is much of an issue on inpatient rotations as I assume most facilities have cameras and plenty of staff around. I wasn't thinking about it at the time, but during my rotation I found myself interviewing a lot of pts in an open conference room or multi-purpose conference room. What about on outpatient rotations? I doubt most psychiatrists use video cameras in their offices. It seems like there is a lot of liability in being alone in a room with a patient. OTOH, how can you adequately provide therapy without it?


Has anyone heard of cases where a psychiatrist was falsely accused? What is the burden of proof in these cases? I mean if there is proof like an email proving a relationship or the psychiatrist admits to it, that is one thing, but what about cases of he said, she said? I think this is particularly a concern in residency as I can see a PD easily firing a resident on accusation to avoid exposure. So do we just accept this rare, but incredibly damaging/unjust risk? I am really worried about something like this affecting my livelihood/ability to support my family.

 

[whopper]

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

Yes.

How often? I don't know because I haven't seen any numbers. As mentioned above, most patients with such problems don't have the money to sue. To be litigious you have to have enough money to pay a lawyer or you have to have such a rock-solid case that will produce such a tremendous reward that the lawyer will be willing to work without pay during the case but then demand a higher amount of the reward.

From personal experience I'd say poor patients almost never sue, while unfortunately rich paranoid patients sue quite a bit. A buddy of mine went through such a case. He's a forensic psychiatrist that was hired by a paranoid person with money that was fired because his paranoia was causing him to get into the faces of other people. E.g. point fingers at them and make claims that he knew they were plotting against him in such an outrageous and disruptive, not to mention creepy manner with his coworkers.

So he sued his employer, and hired my buddy to do an evaluation to prove he wasn't pathologically paranoid. Well guess what? He was, and my buddy is not a hired gun who'll say anything, so he told the lawyer he couldn't give the testimony the plaintiff wanted. The plaintiff then sued my buddy claiming that my buddy was against him from the start! Legal fees went over 6 figures!

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

False accusations happen, and I've seen horror stories happen but for the overwhelmingly most part the accuser already has no credibility. Further, if you take the proper precautions, you will be seen as the victim. E.g. have a chaperone such as nurse present and if the patient makes an accusation you have a professional as a witness to protect you. State Boards, hospitals, most institutions only believe the accuser if there is actual evidence or a clear pattern (E.g. several accusers that don't know each other making similar accusations, etc).

As for the horror stories, not surprisingly they too involved people with money. A friend of mine, his father is a psychiatrist that had a former patient accuse him of raping her when he refused her sexual advances. She hired a lawyer and specifically had the lawyer do every dirty trick in the book to screw up the psychiatrist even knowing they would eventually fail but in the meantime put that doctor in a very uncomfortable position. She was willing to dump her money to make him suffer and could afford to do this while spending tens of thousands of dollars in lawyers fees.

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Some aspects such as involuntary commitment in a locality where the practicing doctor has to go to the stand? You could be in court quite often. Other areas-you'll hardly ever go to court at all unless you're sued and malpractice suits are actually quite low in psychiatry compared to the other fields. While I know of no scientific data explaining why my theory is that patients are ashamed to bring about their mental illness in public and would rather just put it behind them. I know because I've had plenty of patients that suffered from egregious malpractice and when I asked why they didn't sue, they told me they were too ashamed for anyone to find out their "secret." E.g. A patient developing stage IV renal disease because her doctor put her on lithium with NO LABS for years, even after she developed kidney problems.

 

[pml1224]

Whopper, thank you for the very detailed post. That is very scary indeed. I feel bad for your colleagues. Six figure legal fees, that is insane! I hope some of that was covered by malpractice insurance otherwise that would ruin him. I guess it is a rare occurrence, but I don't know how psychiatrists don't practice with some extra protection like a scribe or a video camera. I understand patients wont like that, but I think it just comes with the territory with such a risky population. It kind of reminds me of all of those people who put video cameras on their cars in Russia. And there are really scary cases like this.............

http://www.theguardian.com/uk/2006/aug/03/ukcrime.uknews21


I'm sorry to be such a debbie downer, I just really like psychiatry, but I am so worried about these potential risks that can ruin your life. At least in cases of malpractice (even really egregious cases) you can settle. Unless you actually commit assault on a patient you don't have to worry about losing your license and going to prison.

 

[whopper]

I wouldn't be worried about it. Psychiatry's legal woes are actually quite small compared to other medical fields out there. The situations I told you were extreme. As for my buddy, yes he was covered by his insurance so don't worry about it as if psychiatry is somehow worse. It's actually better in comparison. When I was paying malpractice it was on the order of about $15K a year. Ob-Gyns could pay > $100K a year for their insurance.

Another buddy of mine, his father-in-law is a bariatric surgeon. If the person gains weight after a surgery, a lot of those patients sue expecting it to be a quick-fix into weight loss. The problem here is even with bariatric surgery the person still has to make lifestyle modifications and this is coming from a demographic that for whatever reason wasn't making those modifications before the surgery. His malpractice company just tells him to settle because even though he's in the right it'll cost him more money to actually go through with the lawsuit vs. pleading not guilty.

And let that be a lesson for all you who falsely claim that if you do forensic psychiatry you don't need malpractice. Phil Resnick in the AAPL board review course says you do! I've seen several attendings tell residents forensic psychiatrists do not need malpractice. That is a big no-no.

 

[Ibid]

I was just wondering, how litigious is the everyday practice of outpatient/inpatient psychiatry? If you ask me, a non-psychiatrist, I would assume psychiatric practice to be an extremely litigious career given the often contentious, and even hostile, nature of some patient interactions....I mean, one can easily imagine how paranoid patients can simply falsely accuse their psychiatrist for doing something wrong!!!

-Do psychiatrists ever get falsely accused by their paranoid or psychotic parients? How often?

-Do psychiatrists get pulled into courts often to give testimonies on their patients? For example, defending a Mental Capacity assessment, defending orders to restrain a patient?

-Do psychiatrists practice with the "fear" of being falsely accused by their paranoid patients?

So, how Legaly Involved is the practice of psychiatry. By "Legaly Involved" I mean anything that has to do with courts and lawyers, not necessarily lawsuits in particular.

Thanks

Without mental health legislation it is argueable that the speciality of psychiatry would just about disappear..... probably some sort of lifestyle coaching along with prescribing rights..... but without involuntary commitment to keep the show on the road it would be lights out...... mostly....

 

[whopper]

I don' t think psychiatry would disappear. Think about it. If 1% (I know it varies per study but about 1%) of people have schizophrenia, for a place like NYC that has 8.3 million people, how many will have schizophrenia? 83,000!! Add to this problem that in NYC things are cramped. You could have hundreds, maybe even thousands of people living within just one block due to high rises or cramped in tenements. That puts those people right in your face.

Without legislation there would be utter chaos but most societies would start grabbing these people and trying to do something about them. Back then they had asylums. Without legislation, the situation becomes more chaotic but there's still THE SITUATION. It'd be like a large urban center having no fire department. It will have to have one or it'll eventually burn down.

But even if schizophrenia were to magically disappear there's still plenty of people that need psychiatric help, just that a major faction of our profession would be gone.

 

[Ibid]

I don' t think psychiatry would disappear. Think about it. If 1% (I know it varies per study but about 1%) of people have schizophrenia, for a place like NYC that has 8.3 million people, how many will have schizophrenia? 83,000!! Add to this problem that in NYC things are cramped. You could have hundreds, maybe even thousands of people living within just one block due to high rises or cramped in tenements. That puts those people right in your face.

Without legislation there would be utter chaos but most societies would start grabbing these people and trying to do something about them. Back then they had asylums. Without legislation, the situation becomes more chaotic but there's still THE SITUATION. It'd be like a large urban center having no fire department. It will have to have one or it'll eventually burn down.

But even if schizophrenia were to magically disappear there's still plenty of people that need psychiatric help, just that a major faction of our profession would be gone.

Yes.... I agree with what you are saying.... I suppose I have a utopian vision of society being much more tolerant of difference and making space for people..... that would involve fewer people being labeled with schizophrenia (this bit is possible I believe) and people just being given housing and social support where they are..... I believe this would be cheaper in the long run than people going in and out of hospital and living in hostels then the street then hospital then back to the street/hostel. If they were just given a home it would be cheaper. Can't see it...... firstly their is a bias against looking after people by just providing things that are argueably just a human right and secondly their is money to be made in the current set up...... to many people make a good living out the faulty system that exists and their is nothing in it..... or perceived to be nothing in it for society at large or for people making a good living in the helping industries....

 

[endrun]

People with mental illness do exist in the world outside of a psychiatrist's office. It's not as if psychiatrists are unique in interacting with people who have mental illness. People with mental illness also see general practitioners, dentists, hairdressers. They go to restaurants. They live with families, who sometimes are also caretakers for them. I suppose psychiatry is unique in that while in a psychiatrist's office, you're aware that people are there specifically for the purpose of diagnosing or treating a mental illness, but the interesting thing is that when you start talking to people in almost any random environment, you'll find out how common diagnosed mental illnesses are, along with psychiatric medication usage, or symptoms of mental illness.

This is a very obvious thing to say, and maybe shouldn't be pointed out for that reason, but sometimes the conversations on these boards seem to sort of take the population and both make it sound like psychiatric illness is the last word on a person's life and also that no one else meets with people with mental illness.

Think of people who work in bars and diners. Flight attendants. They deal with people in disorganized states of mind all the time.

As far as false accusation, I think it was discussed on this board before, and there was somewhat of a consensus that not enough is done on behalf of the patients in cases of patient complaints, and that if there are illegitimate complaints, they're more of a pain in terms of paperwork for the practitioner than anything else. Where I live there is a psychiatrist who is known as the guy who hands out anything a patient asks for. Another is known as a cult leader (not kidding, as much as I've not been believed when mentioning this before). And as much as other professionals encourage patients to report them, I've never even seen a sanction against them appear on their state profiles.

Yes, the entire world is sick, and we Psychiatrists are there to make it well. Or, perhaps, maintain the world in its current dilapidated status.