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"
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
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