The Ethics of Tailoring the Patient's Chart

Because psychiatrists cannot include everything they observe and everything the patient says in the medical chart, they must select and tailor what goes into the chart. They should tailor the chart to focus on what is significant for the diagnosis and treatment of the patient. However, sometimes they tailor the chart for other purposes: to ensure that managed care will cover continued hospitalization, to protect themselves against malpractice claims, to secure a civil commitment, or to obtain a long-term placement for the patient. The authors of this paper present and analyze four cases in which psychiatrists tailor charts for these purposes. They discuss whether each psychiatrist's actions are ethically justified and consider whether tailoring the chart is a deceptive practice. In each case, they present reasons for and against this practice and suggest truthful alternatives designed to improve patient care, preserve social trust in the profession of psychiatry, and challenge serious failings in the health care system.