March 29, 2013

The issue of confidentiality is problematic for civil forensic psychiatrists. Most of us err on the side of caution and have claimants sign a document acknowledging that the information they provide will be incorporated into a report. The information is otherwise kept confidential by me. I have no control over what happens to the report however.

We assume that because people arrive they have given implicit consent to release of information. I was involved in a recent matter before the Medical Board of Australia where the issue in question was that the “practitioner prepared and provided a report to try and company which included a possible diagnosis, without having met performed a clinical assessment of the complainant.”

in brief a complainant had arrived for a medicolegal assessment by a psychiatrist with regard to his workers compensation claim. He refused to sign the full disclosure document and was told the interview could not proceed. In the interim the psychiatrist overheard him dealing with office staff and thought he was aggressive and angry. Documentation provided to the psychiatrist indicated that he had been described as a difficult employee and “paranoid”. The psychiatrist wrote a briefing note to the insurance company stating why he had not been able to complete the examination. The psychiatrist went further. The psychiatrist wrote that he was concerned about the complainant’s behaviour and thought there was a “possibility that he does have a significant psychiatric illness” and “may have a paranoid disorder”. The psychiatrist urged the insurance company to warn future assessors that the complainant may be difficult and may make complaints about them although there was no indication of any physical threat.

This letter was used by the insurance company to deny the claim and, somewhat unwisely, the psychiatrist agreed to the release of this letter to support their decision. This led to the complainant making a complaint to the Medical Board of Australia.

Another experienced psychiatrist formed the view that he had breached confidentiality. My opinion was that behaviour had been observed in a public place ie the waiting room and that confidentiality did not apply. See definitions below.

Definitions of Medical Confidentiality

Psychiatry: The ethical principle that a physician may not reveal any information disclosed in the course of medical care.
McGraw-Hill Concise Dictionary of Modern Medicine. © 2002 by The McGraw-Hill Companies, Inc.

A substantive rule in bioethics saying that the information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party; usually the provider must obtain permission from the patient to make such a disclosure.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

confidentiality /con·fi·den·ti·al·i·ty/ (kon″fĭ-den″she-al´ĭ-te) the principle in medical ethics that the information a patient reveals to a health care provider is private and has limits on how and when it can be disclosed to a third party.
Dorland’s Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

The second issue was whether he was entitled to report on the behaviour he had observed and overheard. In my view he was. The third issue was whether this constituted a psychiatric report. In my view it did not. I understand a psychiatric report to be amassing considerable amount of data, doing a mental status examination and using that information to form an opinion. This did not appear to be the situation. I thought the critical matter was whether or not the psychiatrist had been fully frank in stating what informed his concerns. I believed he had done so.

This matter raises the further issue of the experience of many civil forensic psychiatrists that if claimants are not happy with the report they make a formal complaint about the psychiatrist.

I would be interested in your views on this matter. By the way the psychiatrist on the matter referred to above was found to have no charges to answer.

I have provided for your interest a link to a consent form to release claimant’ s information.


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