Forensic Coverage; Documentation Crucial

Q. I am currently in private practice. Recently I was asked to provide expert witness testimony. When I mentioned this offer to a colleague, she advised me to check my professional liability insurance policy to verify that I have coverage for forensic activities. Don't all policies cover forensic services? If not, do I really need to be concerned since only a small percentage of my practice would be focused in this area?

A. Many insurance carriers classify forensic services as nonmedical because this professional activity by a psychiatrist does not involve the direct treatment or care of a patient. Thus, these insurance carriers do not cover claims arising out of forensic services. This could be problematic as courts are imposing greater duties and liability on physicians performing forensic services, such as expert witness testimony. A policy with the Psychiatrists' Program defines psychiatric services as medical services directly related to the practice of psychiatry or behavioral health care with respect to evaluating, diagnosing, or treating a mental disorder and routine medical care incidental to the provision of such services to patients. With the Psychiatrists' Program, forensic psychiatric activities are covered at no additional charge.

Q. I am a psychiatrist who recently graduated from residency. I have opted to start a private practice, but I'm concerned about the risks of practicing without the supports that hospital staff psychiatrists automatically have at their disposal. How can I avoid being sued for medical malpractice without resorting to practicing “defensive” medicine?

A. Because the primary goal of risk management is to provide for adequate patient care, the most effective way to reduce your risk of being successfully sued is to practice good medicine while documenting the same.

Practicing good medicine entails remaining focused on patients' clinical needs, carefully monitoring medications, being diligent with follow-up care, and staying current with advances in the field. As a treating psychiatrist, you are obligated to obtain an adequate medical and psychiatric history, conduct an appropriate examination, and follow up at reasonable intervals to assure that treatment is progressing as desired.

Medication levels and appropriate physiologic functions should be monitored regularly along with patient compliance. If you are prescribing medications, be sure to consult reputable treatment guidelines (for example, APA's practice guidelines, AACAP's practice parameters). Useful information for patients, as well as physicians, about medication is accessible at the Food and Drug Administration's Web site at<www.fda.gov/cder/drug/DrugSafety/DrugIndex.htm>.

Don't forget to document carefully and contemporaneously your clinical care and decision-making processes. Remember the adage, “If it wasn't documented, it wasn't done.” This is a useful reminder that the purpose of documentation is to provide for good patient care. In short, the medical records you create will serve as your best tangible defense in the event that a patient sues or makes a medical board complaint.

Maintaining competency is imperative for psychiatrists. Avenues to achieve this include consulting with other colleagues, joining APA and your state medical society, attending continuing medical education courses, and consulting professional literature. APA provides myriad resources, one of which is Practice Management for Early Career Psychiatrists: A Reference Guide. This 2008 publication is a handy reference guide for any psychiatrist thinking of starting a practice.

Participants in the Psychiatrists' Program have access to additional resources such as detailed articles and tips on specific topics of interest and phone consultations through the Risk Management Consultation Helpline at (800) 527-9181. The Helpline operates from 8:30 a.m. to 5:30 p.m. Eastern time.

This column is provided by PRMS, manager of the Psychiatrists' Program, for the benefit of members. More information about the Program is available by visiting its Web site at<www.psychprogram.com>; calling (800) 245-3333, ext. 389; or sending an e-mail to [email protected].▪