Interest on the part of psychiatrists in issues involving psychiatry and the law has risen sharply since the last revision of this excellent book a decade ago
(1). Concerns about patient privacy and confidentiality or the lack thereof, limitations imposed by managed care, and the effects of AIDS have all contributed to the concerns of psychiatrists as well as legislators, courts, and regulatory agencies. Malpractice issues are understandably of increasing concern to psychiatrists. The authors tell us that “the incidence of malpractice claims for 100 psychiatrists has risen from 0.6 claims in 1980 to approximately 4 claims in 1990 to 10–12 claims in the late 1990s.” What are the chances that a clinician can avoid a claim over a 40-year career, with all the emotional and financial risks such claims entail. The authors also note that premiums have risen dramatically, especially in high-risk states.
The chapter subjects are confidentiality and privilege, legal issues in emergency psychiatry, legal issues in inpatient psychiatry, malpractice and other forms of liability, competence and substitute decision making, forensic evaluations, clinicians and lawyers, and the clinician in court. The entire content is geared toward the clinician, although forensic evaluations might best be the province of forensic subspecialists if such are available. Emergency and inpatient issues should be of particular concern to residents, their supervisors, and on-call physicians.
The format of the chapters is unchanged since the first edition. Each follows the same sequence: case examples, legal issues, clinical issues, pitfalls, case example epilogues, action guide, and selected readings. The wise reader will resist the temptation to jump from the intriguing vignettes that start the chapters to the epilogues that present the resolution without first going through the intermediate considerations, which are the substance of the handbook. I found it particularly useful that the suggested readings are easy to find immediately following the clinical material to which they refer. These references are current, many of them new since the last edition. For instance, in the chapter on competence and substitute decision making, the earliest reading cited was written in 1989. The law does move in its own way to deal with changing reality, in this instance an aging population.
I highly recommend this book to psychiatric residents and their mentors, practitioners in all mental health disciples, and those who appreciate a lively style to accompany serious content.
