At Your Service
Can a Treating Psychiatrist Double As Expert Witness for Same Patient?
Psychiatric News
Volume 39 Number 16 page 16-16

Q. A patient asked me to evaluate her for a workplace disability claim. She is claiming that her depression was caused by harassment on the job. I'm uncomfortable agreeing to such a claim as she has a long history of psychiatric problems, including depression. Can I effectively provide treatment and forensic services to the same person?

A. In general, acting as both a treating psychiatrist and performing an evaluation for legal purposes (or acting as an expert witness) could adversely affect both the therapeutic relationship and your objectivity as an expert.

These are two common scenarios in which psychiatrists find themselves:

In these scenarios, the psychiatrists are initially treating psychiatrists. Once they start giving opinions for the purposes of litigation or employment, however, they move beyond the role of treating psychiatrist and into the role of forensic psychiatrist or expert witness.

Multiple roles bring with them the very real possibility, even the inevitability, of conflicting obligations (that is, the patient's clinical needs versus the patient's legal needs). Conflicting obligations increase the risk of clinical, ethical, and legal problems.

The American Academy of Psychiatry and the Law states in its Ethical Guidelines for the Practice of Forensic Psychiatry, "A treating psychiatrist should generally avoid agreeing to be an expert witness or to perform evaluation of his patient for legal purposes because his forensic evaluation usually requires that other people be interviewed and testimony may adversely affect the therapeutic relationship."

It is appropriate for a psychiatrist, as the treater, to provide factual information in a report or testimony about the patient's clinical status, with proper consent from the patient, but if the assessments, recommendations, and opinions do not exactly match the litigation needs of the patient/party as the lawsuit develops, then the psychiatrist's usefulness as a witness is finished. He/she might even be detrimental to the patient's case, which could have serious implications for the therapeutic relationship.

If, in contrast, a psychiatrist tailors his/her assessments, recommendations, and opinions to the needs of the lawsuit, then his/her effectiveness as a treating psychiatrist is compromised, if not destroyed, and he/she may fall below the standard of care.

In either situation, if the patient thinks he/she has been harmed by the doctor's involvement, the patient may then have a cause of action against the psychiatrist based in negligence (that is, negligent treatment or negligent forensic evaluation).

Psychiatrists should be wary when asked for opinions or predictions by third parties, such as patients' employers, disability insurance companies, and attorneys. The safest response is for the psychiatrist to discuss the issue with the patient, explain the limits of his/her role as a treating psychiatrist, and outline the potential conflicts. The psychiatrist can advise the requesting parties that if they want a specific opinion or prediction, then they should obtain an independent medical exam for that purpose. Unfortunately, psychiatrists who practice in small towns or rural areas sometimes find that it is difficult to avoid dual roles.

Many medical professional liability insurance policies do not cover the risks inherent in forensic practice, but forensic work is covered under the APA-endorsed Psychiatrists' Professional Liability Insurance Program.

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 TheProgram@prms.com.

Interactive Graphics


Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Articles