When Patients Diagnose Themselves and Request Specific Treatments

Technology in health care has empowered patients to be engaged, active participants in health care decisions. As technology evolves, one could ask, Will a patient’s access to online health information cause a disruption to the delivery of health care? In some cases, we have seen patients receive misleading information from outside sources, leading them to stop following their psychiatrist’s prescribed plan of care. Let’s review potential risks when patients use the internet for diagnosis, symptom management, and treatment.

With increased engagement and use of patient portals, health care consumers expect their medical information instantaneously, and this often leads patients to the internet to learn more about their diagnoses. Oftentimes, this causes stress and anxiety as patients try to interpret medical information on their own. Patients may even begin treatment prior to the advisement of their physician, all because the internet was their source. Research shows people with depression are likely to search information online due to the stigma attached to mental health and a reluctance to have a discussion with their physician.

Psychiatrists need to be prepared to respond to patients who present with their own research and request tests or medications that may not be indicated. For starters, assess patient engagement and risks for noncompliance or nonadherence.

Patient autonomy is important and helps foster positive relationships and satisfaction. Consider listening actively to patients, use open-ended questions when discussing treatment options, and be empathetic and free from judgment. Respecting autonomy and collaborating with patients will help to develop safe and effective care plans consistent with patient goals and preferences.

Collaboration is not always easy, and psychiatrists must offer comprehensive information about a patient’s health condition, treatment options, and potential risks and benefits. Regardless, patients may still make decisions that are not in their best interest or pose risks to their health and safety.

Psychiatrists have an obligation to ensure patients have sufficient information to make informed decisions. However, they are not required to offer treatment outside the standard of care or make recommendations violating ethical or legal standards. An informed consent process should include treatment options that outline potential risks and benefits. As part of risk assessment, psychiatrists should identify, evaluate, and decide the likelihood of the risk. Documentation of the informed consent process is essential and must reflect patient understanding. When a patient declines recommendations for care, document the informed refusal. Assess for reasons for potential noncompliance and nonadherence.

Reasons behind a patient’s nonadherence can be multifaceted and often driven by finances, access to care, or health care literacy. Nonadherence can also be intentional and based upon belief systems and knowledge. Psychiatrists are encouraged to collaborate with patients through resolution or consider offering consultation or collaboration with another provider to prevent future problems and liability. Sometimes termination may even be considered.

Psychiatrists can take steps to manage these challenges:

• Listen: Psychiatrists should listen to patient preferences and goals related to care and treatment.

• Educate: Supply comprehensive information about the patient’s health condition, treatment options, and the risks and benefits of care. Educate patients about the importance of obtaining accurate and reliable information from reputable sources.

• Autonomy: Allow patients to make their own decisions about care if those decisions do not conflict with ethical and legal obligations, including respecting the patient’s right to refuse.

The internet has transformed health care, supplying easier access to medical information; however, although a valuable resource, it also presents risks for patients. Through education and collaboration, psychiatrists and patients can develop comprehensive care plans to manage risks and ensure positive patient outcomes. ■

This information is provided as a risk management resource for Allied World policyholders and should not be construed as legal or clinical advice. This material may not be reproduced or distributed without the express, written permission of Allied World Assurance Company Holdings, Ltd, a Fairfax company (“Allied World”). Risk management services are provided by or arranged through AWAC Services Company, a member company of Allied World. © 2023 Allied World Assurance Company Holdings, Ltd. All Rights Reserved.

Tracey Angelo, B.S.N., C.P.H.R.M., F.A.S.H.R.M., and Cara Staus, C.P.H.R.M., F.A.S.H.R.M., are risk management consultants in the Risk Management Group of AWAC Services Company, a member company of Allied World. Risk Management services are provided as an exclusive benefit to insureds of the APA-endorsed American Professional Agency Inc. liability insurance program.