Psychiatry - November 2008 - (Page 51)

[risk management] treatment guidelines and policies and procedures the same as the standard of care? Am I committing malpractice if I deviate from them in the treatment of my patients? ANSWER: Treatment guidelines and policies and procedures do not by themselves definitively establish the standard of care. The standard of care against which a psychiatrist’s conduct will be measured in a malpractice action is that of a similar psychiatrist in similar circumstances. A judge or jury will consider treatment guidelines or policies and procedures as just one piece of evidence, along with other evidence, such as experts’ testimony about prevailing medical practice, to define the applicable standard of care. Reputable treatment guidelines and policies and procedures often constitute a consensus of experienced practitioners as to the prevailing medical practice in a given situation. Since the standard of care is largely determined by peers based on what the conduct of a psychiatrist should be under the circumstances, treatment guidelines and policies and procedures may closely approximate the standard of care. Human variation precludes the development of a predetermined standard for every possible situation. Every clinical situation is different and reasonable psychiatrists can disagree; in fact, treatment guidelines sometimes conflict with each other. Should a psychiatrist deem it necessary to deviate from a recognized guideline, the psychiatrist should document and justify his or her reasoning for the deviation. A psychiatrist should not be deemed negligent per se simply for departing from guidelines nor deemed innocent simply for adhering to them. In the litigation arena, treatment guidelines are one tool that can be used by both plaintiffs and defendants. Plaintiffs try to use guidelines to show that the defendant failed to observe standards of practice, whereas defendants use guidelines to show that they did observe standards of practice. For this reason, compliance with guidelines may work to the psychiatrist’s advantage if they are widely recognized as authoritative. While such compliance will not conclusively defeat a negligence claim, it can go a long way toward defeating the plaintiff’s argument. As mentioned previously, a defendant psychiatrist who departed from authoritative guidelines will almost certainly have to explain his or her reasoning for the departure in court. Psychiatrists who do depart from authoritative guidelines should take care to document their reasoning and decision-making processes in patient charts. Contemporaneous documentation is one of the most powerful forms of evidence for a defense. Reputable treatment guidelines and policies and procedures developed by professional societies must not be confused with utilization review or protocols used by managed care organizations that are influenced by economic considerations. Adherence only to utilization review and other similar protocols that do not necessarily have an authoritative clinical basis will not protect the psychiatrist in the courtroom from allegations that his or her care fell below the standard of care. intended for publication by the authors should state this in the e-mail. Published questions are edited and may be shortened. SUBMIT YOUR OWN QUESTION To submit a question, e-mail Elizabeth Klumpp, Executive Editor, eklumpp@matrixmedcom.com. Include “Risk Management Column” in the subject line of your e-mail. All chosen questions will be published anonymously. All questions are reviewed by the editors and are selected based upon interest, timeliness, and pertinence, as determined by the editors. There is no guarantee a submitted question will be published or answered. Questions that are not [NOVEMBER] Psychiatry 2008 51

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Psychiatry - November 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Measuring Adverse Events in Psychiatry Nonsuicidal Self Injury in Adolescents Relative Tolerability of Alzheimer's Disease Treatments Biracial Identity Development and Recommendations in Therapy Depression and Cardiovascular Disease: Just an Urban Legend? Three Risk Management Basics Journal Watch Classified Advertising Information for Authors

Psychiatry - November 2008

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