May I Provide Care to a Team Member?

Q: I have a question on boundaries and implications for jeopardizing confidentiality. We have a fellow therapist with whom I share clients and who wants to see me as a patient. The therapist’s case may be discussed (as a patient) in the team meetings we have weekly with other psychiatrists in the group. All other psychiatrists in the group also share patients with her. Technically, since she is a postdoctoral student and we are a part of a university, we cannot refuse care if the patient wants it. I am looking for APA guidelines in this type of situation.

A: The scenario you pose is a dual-agency problem. You and the postdoc student already have a psychiatrist/cotherapist relationship; it would not be right to add a physician/patient relationship on top of that. Further, of course, you couldn’t discuss her personal treatment in team meetings with the other psychiatrists, but that would be just the beginning of potential conflicts. You must decline to treat her yourself. What you can, and should, do is offer to help her find a psychiatrist away from the university setting, someone whose work you respect, and thereby make a genuine effort together to get her into the right hands. You shouldn’t assume that because she is part of the university, you are obliged to take her as a patient. ■

Claire Zilber, M.D., is a member of APA’s Ethics Committee. The information in this column is taken from the Opinions of the Ethics Committee on the Principles of Medical Ethics. Click here to access the document; then click the hyperlink for the Opinions of the Ethics Committee on the Principles of Medical Ethics.