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Malpractice worries-psychiatry


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I posted this topic on the Huddle a while back but didn't get any replies. Trying again.

My SP and I have different opinions on this therein lies the problem. I have worked in psychiatry for 2+ years but recently started in a new practice with a new SP (brand new-just finished her residency).

 

When does a patient-provider relationship begin. And what causes that relationship to begin? The appointment being made? Doing the assessment? "Accepting them for care?" Providing them with a treatment plan?

 

I have done assessments in the past and told patients that I could not help them for one reason or another. Gave them a referral to someone else. Billed insurance. Took the copay. And life went on. That's what everyone was doing.

 

Go to my new practice. The psychiatrist took a class in med school and says if you take money that establishes a contract and don't take their money. And also find out acuity early in the visit and tell them within a few minutes if you are not going to accept them. So I have a high acuity patient that I don't complete the assessment. And don't do anything except basically tell them they should have gone to someone else. Give the name of someone else. No billing. No copay and send them out. Seems very risky to me. Much riskier than doing a complete assessment but she's the SP.

 

Thought about talking to some attorneys.

Thanks for everyone's input.

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It's a very different situation but when I was in Urgent Care, we could elect to "no-charge" a visit if circumstances made it appropriate to do so. That wouldn't mean we wouldn't document.

 

Why can't you just not bill for the visit, but also put in a quick two paragraph narrative about the situation, and why the patient was advised to seek care elsewhere? That would allow you to keep a documentation trail and support your clinical reasoning, plus it would be a way to record the referral that was made to elsewhere. 

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What Febrifuge said.    I can talk to someone for 90 seconds in UC and do a quick assessment and tell they are in the wrong place.  We no charge them but I still write a few notes in chart about why I couldn't see them and they needed to go to the ER without a work up here and why they were stable enough to go POV (or that I called 911, etc). 

 

We do the same thing in my out patient pulmonary - granted a much rarer occurrence but occasionally we get a patient with specific needs that we just can't meet.  We write in the chart why we can't meet them and who we referred them too. 

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