The Texas Society of Psychiatric Physicians (TSPP) had over several decades published Guidelines for psychiatrists which outlined the expectations of the psychiatrist when involved with inpatient treatment, partial hospital programs , consultation services, and other modalities of treatment. In 2016, The Professional Practice Management Committee recommended that these Guidelines be retired as the information contained in the Guidelines might be found in diverse sources such as hospital bylaws, utilization review documents, managed care organization policies, and American Psychiatric Association (APA) publications.
The Professional Practice Management Committee decided that rather than continue with specific Guidelines, broad principles should be put forth that promote excellence in the practice of psychiatry . These principles reflect Professionalism which has been briefly defined as “……a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.” (see JAMA reference below).
Four principles are put forth which we believe a psychiatrist should aspire to. These are not presented as “duties” or “obligations”, but more as virtues. Of course, the psychiatrist has a duty to his/her patient. This means that the doctor – patient relationship is based on trust and in confidence that the doctor will act in the best interests of the patient. This relationship takes priority over reimbursement considerations.. Acting in the best interest of the patient takes priority over the relationship that the physician might have by virtue of contract or employment with a hospital, accountable care organization, managed care organization, or any other entity.
STATEMENT OF PRINCIPLES ON PROVISION OF PSYCHIATRIC SERVICES TO PATIENTS
- The psychiatrist should remain well-versed in psychopharmacology and other somatic treatments and psychotherapeutic techniques, as well as clinical methods of patient evaluation and therapies.
- The psychiatrist should be familiar with developmental and social forces that impact a patient, as well as spiritual and cultural aspects of relevance.
- The psychiatrist should be broadly familiar with developments across medicine, neuroscience, social sciences, and other disciplines that may contribute to patient care. This implies attention to relevant domains of knowledge beyond required continuous medical education (CME) requirements. In other words, simply obtaining the required hours of CME does not complete the psychiatrist’s professional obligation to maintain a substantial base of knowledge suitable for provision of psychiatric services.
- The psychiatrist should advocate , as necessary, for his/her patient. This may include appealing for overrides on prescriptions that are not authorized; documenting the need for services that may not be approved; and generally assisting the patient with education or intervention, as necessary, to assure the availability of an adequate treatment plan.
2. Quality care is contingent on the psychiatrist spending sufficient time with the patient, family members, or other sources of information (e.g., medical records, consultation reports). A demand for “productivity” should not compromise the amount of time the physician determines to be necessary to adequately address clinical needs. Excellent care should have priority over “production” and be compensated accordingly.
3. Advocacy includes working within healthcare systems to assure quality psychiatric treatment is available and to assist in establishing appropriate standards of care and quality measures.
- A psychiatrist should maintain comprehensive oversight of all aspects of care, including those interventions which s(he) is not directly providing, as much as is feasible and as required by law and/or regulation.
- The psychiatrist should know the person being treated regardless of the specific treatment (e.g. medication management, ECT, etc.). Awareness of family history, prior treatments and their outcomes, and the array of relevant biopsychosocial variables should be appreciated by the psychiatrist even in situations where the psychiatrist’s role is limited.
- The psychiatrist should strive, in collaboration with colleagues, relevant medical organizations, and political systems to set the standards of care in matters of psychiatric treatment and delivery of mental health services. Standards should derive from the training, knowledge and experience of psychiatrists and not be solely determined by insurance companies, legislatures or other governing bodies, or any other entity which attempt to regulate psychiatric services. This principle may be best accomplished by active participation in professional organizations that address psychiatric treatment and mental health interests.
- The psychiatrist should communicate and collaborate, when indicated and professionally appropriate, with other clinicians and caregivers involved in services to patients.
2. The psychiatrist should encourage patients to responsibly participate in their care by addressing issues of treatment adherence; by negotiating treatment options; and by encouraging patients to learn about diagnoses, courses of illness, medications, and treatment options. This is in the service of informed consent and collaboration.
3. A psychiatrist should educate patients, families, and the public on mental health matters.
American Psychiatric Association.2001. The Principles of Medical Ethics: with Annotations Especially applicable to Psychiatry. Washington, DC: American Psychiatric Association.
Radden J & Sadler J. The Virtuous Psychiatrist: Character Ethics in Psychiatric Practice. Oxford University Press, 2010.
Livingston EH, Ginsberg S, Levinson W. Introducing JAMA Professionalism. Introducing JAMA Professionalism. JAMA August 16, 2016 volume 316, Number 7 pp 720-721.
Approved by TSPP Executive Council 11/2016