Education Is Key to Managing Practice Risks
Q. I practice in California and would like to attend a risk management seminar in my area. Will the Psychiatrists' Program be presenting any risk management sessions on the West Coast?
A. Yes. The Psychiatrists' Program will be presenting a risk management session during the 16th Annual California Psychiatric Association Premier Conference. The seminar, titled “The Monster in the Closet: Professional Liability and Risk Management in the Practice of Psychiatry,” will be conducted in two parts on Saturday and Sunday, October 9 and 10, from 7 a.m. to 9 a.m. Jacqueline Melonas, R.N., M.S., J.D., vice president of risk management at PRMS, will present the seminar.
This seminar will focus on high-risk areas of psychiatric practice and how to reduce related professional liability risks by using risk management strategies.
As a benefit of participation in the Psychiatrists' Program, attendees of this seminar are eligible to earn a 5 percent premium reduction on their Program insurance premium. Program participants are encouraged to call their underwriter at (800) 245-3333 with any questions regarding the risk management discount.
The meeting will be held at the Napa Valley Marriott in Napa, Calif. To register for the CPA Premier Conference, please contact the California Psychiatric Association directly at (916) 442-5196 or download a conference registration form at<www.calpsych.org>.
The Psychiatrists' Program will also be presenting an all-day risk management seminar titled “Staying on Track: Risk Management Strategies for Psychiatric Practice” on Friday, September 17, at Oak Brook Hills Resort, Chicago/Oak Brook, Ill.
To obtain more information or to register, visit<www.psychprogram.com> or call (800) 245-3333, ext. 310.
Q. I have been reading with some anxiety the increasingly critical media coverage of certain psychotropic medications and the recent FDA Public Health Advisory about prescribing antidepressants. I have a number of patients for whom these medications work well; however, the patients are also aware of the current controversy. What risk management advice is there for continuing to prescribe these medications?
A. The efficacy and safety of psychotropic medications, especially in pediatric patients, is an ongoing issue in clinical practice and psychopharmacological research. These issues have received increased attention recently, due in part to strong advisories and safety warnings from the FDA, certain research findings, and numerous reports in the media, which often emphasize the problems and not the benefits of these drugs.
Specific concern about the off-label use of psychotropic medications to treat children, especially younger children, has been voiced by experts and the public. Most recently the debate about prescribing psychotropic medications has focused on the events leading up to the FDA's March 22 Public Health Advisory on the possibility of worsening depression and suicidality in patients being treated with antidepressant medications (Psychiatric News, April 16).
Against this background, physicians' prescribing decisions have the potential to be scrutinized more than ever. Accordingly, psychiatrists should consider using the following risk management strategies to increase patient safety and minimize professional liability risk:
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Stay informed about the medications you prescribe. In addition to sources you frequently use (peer-reviewed or published studies, continuing education courses, professional publications, and so on), the FDA's Medwatch Web site,<www.fda.gov/medwatch/safety.htm>, provides updated safety information about drugs.
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Periodically re-evaluate the medications you currently prescribe and the clinical basis for prescribing. Update treatment plans and recommendations accordingly. Changes in medications or dosages, reassessment of patients, and closer monitoring of patients and side effects of medications may be required, among other clinical interventions. Consultation or getting a second opinion on patients with complicated psychopharmacology issues should be considered.
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Use the psychotherapeutic process to discuss important issues with patients.
Examples of the subjects that should be discussed are diagnosis, medication properties, the physician's previous experience with this medication, special concerns of the patient and the patient's family, comorbid somatic conditions, and the patient's and family's expectations about treatment.
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Update informed consent. New or updated information about the risks and benefits of using a particular psychotropic medication should be discussed and incorporated into the patient's informed consent. On the basis of updated information, some patients may decide to opt out of some treatments, try alternative medications or treatments, or choose another option.
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Document. Document the clinical assessment and clinical judgment that form the basis for treatment recommendations and prescribing decisions. Document significant information about communications with patients and families regarding treatment plan recommendations, including medications. Document the patient's informed consent including the discussion of the nature of the proposed treatment, risks and benefits of the proposed treatment, alternatives to the proposed treatment, risks and benefits of the alternative treatments, and risks and benefits of doing nothing.
This column is provided by PRMS, manager of the Psychiatrists' Program, for the benefit of members. More information about the Program is available by visiting its Web site at<www.psychprogram.com>; calling (800) 245-3333, ext. 389; or sending an e-mail to [email protected].▪
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Published online: 6 August 2004
Published in print: August 6, 2004
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