Simsmedlin4107

Confidentiality has long been a core value in medical ethics, but the parameters of this value have rapidly evolved. The principle is now best understood in the context of competing loyalties Physicians owe patients a broad duty to protect confidences, but that duty is limited-in specific circumstances-by a competing obligation to protect the health of others and the general public welfare. The trend is increasingly toward more disclosure. The author examines three areas in which rules governing confidentiality have rapidly evolved in recent decades-the development of a duty to warn or protect potential third-party victims in the wake of the seminal California case of Tarasoff v. Regents; the establishment of a psychotherapist-patient privilege for the federal courts in Jaffee v. Redmond; and the codification of protections for health information under HIPAA-and how these rules have been implemented. The author also notes the complexities of protecting patient confidentiality in the context of evolving Internet technologies. Copyright © by the American Psychiatric Association.While many of the principles of assessing risk to self and others in adults are applicable to risk assessments of children and adolescents, developmental and legal factors regarding youths give rise to some significant differences. This article highlights major differences in assessing and managing risk in working with suicidal and homicidal youths and gives suggestions for reducing clinicians' liability in these challenging cases. Copyright © by the American Psychiatric Association.Suicide is one of the leading causes of liability against a psychiatrist treating adult patients. Reducing the risk of liability entails understanding the phenomenology of suicide, approaching suicide risk assessment from a clinical perspective, conceptualizing how malpractice cases unfold, examining the issues of foreseeability and proper risk assessment, and developing a risk management approach to mitigate against the potential for a bad outcome. The use of various suicide screening risk assessments in certain clinical contexts is a potentially useful first step in identifying the need for further risk assessment. In conducting a more detailed review of a patient's risk, nonsuicidal self-injury is typically distinguished from suicidal intent and action, although morbidity and mortality can also be associated with any deliberate self-injury. Understanding the concepts of means reduction and risk management planning are essential elements to assist in helping reduce risk. Special attention to risk reduction related to firearms has received increased attention in recent years. Proper assessment, and documentation thereof in clinical records can assist in reducing liability. This article reviews these basic elements for the general practitioner of adult psychiatry related to suicide risk, assessment, and liability surrounding patient suicide. Copyright © by the American Psychiatric Association.In an era of mass shootings and increasing public fear, psychiatrists are more often being asked to assess whether an individual is safe to return to school or work. In addition, assessment of the individual's risk of violence is required in daily clinical decisions regarding the need for hospital care. selleck inhibitor Given the inherent difficulty in predicting violence, mental health clinicians worry about potential liability that could result from their patient committing a violent act. This article provides an overview of malpractice liability for patient violence, violence risk factors, and principles of violence risk assessment. The authors also offer some practical risk management strategies to reduce clinicians' risk of liability for violent acts by patients. Copyright © by the American Psychiatric Association.Medical practice acts and state medical boards have evolved since their conception in the mid-19th century. Today, state medical boards are usually responsible for a variety of functions, with the main function being the detection and discipline of unprofessional and unethical conduct by physicians and other medical professionals. In this article, a brief history of medical licensing and regulation is first provided, with an overview of the structure and process of state medical boards, and how they vary across states. Next, common causes for medical board complaints are discussed, with a focus on complaints against psychiatrists. Last, the author provides general medical-legal considerations that a psychiatrist should contemplate if he or she is the subject of a medical board complaint. Copyright © by the American Psychiatric Association.Fortunately, psychiatrists are less likely to be sued for malpractice than most physicians in other specialties. However, once sued, psychiatrists must navigate a complicated and nonintuitive legal process. This article reviews the major elements of a malpractice claim, the litigation process in medical malpractice cases, and the common allegations of negligence that are encountered in such cases. The major types of malpractice insurance coverage are reviewed, and recommendations about liability prevention and how to best respond to a malpractice action are presented. Copyright © by the American Psychiatric Association.The safety of pharmacotherapy for bipolar disorder during pregnancy and lactation remains a subject of debate and uncertainty. Clinicians must balance concerns about anatomical and behavioral teratogenicity, maternal mental health, exposure to multiple drugs, and heightened risks for peripartum mood episodes. Risk-benefit analyses must consider factors such as illness severity, past pregnancy treatment outcomes, known drug responsivity, psychosocial supports, and key windows during fetal development. Pharmacological decision making usually changes over the course of pregnancy, given developments in maternal physiology and critical relapse risk periods. Among mood stabilizers, given current research, many experts eschew divalproex and carbamazepine, consider lamotrigine relatively benign, and voice strong opinions for or against lithium. Most second-generation antipsychotics are considered relatively safe, apart from possible extrapyramidal and other motor signs of withdrawal after delivery. In this review, the authors analyze the practical questions, current controversies, and available evidence regarding psychotropic drug therapy during pregnancy and lactation in bipolar disorder.