Balancing Practice Policies with Patient Needs

Abstract

is a psychiatrist who has been working in a private practice with several other physicians for quite some time. The practice recently went through a difficult legal action in which allegations were made about a psychiatrist's conduct during a house call. The action resulted in an out-of-court settlement, and the practice put a temporary suspension on house calls while the system and processes were reviewed. In the interim, the clinic psychiatrists were advised to see patients in the office or link them to emergency services if an office visit was not possible. All of the practice's clients received notices, and verbal and written consent were obtained to ensure that they understood the temporary change in the policy. Psychiatrists who continued to make house calls would risk suspension from the practice. One day, the practice receptionist received a phone call from a patient who was frantic and repeatedly asked to speak with Dr. Rekai. Dr. Rekai took the call. It was Rebecca, a usually stable patient, who was having a crisis. Dr. Rekai believed that Rebecca should be seen immediately and suggested that she go to the emergency room (ER) or call an ambulance to take her there, but Rebecca adamantly refused. Dr. Rekai and the receptionist attempted to reach the managing partner (who had overseen the change in policy), but she was out of the office and unavailable. Dr. Rekai had no patients scheduled for the next few hours and contemplated going to Rebecca's house despite the clinic's prohibition on house calls. Commentary Dr. Rekai's available options for a plan of care are intertwined with external arrangements that force her to consider factors outside of the patient-doctor relationship. Without necessarily intending to do so, a clinical practice's policies may oppose the ethical standards of individual clinicians' practice of medicine. These ethical standards may be dictated by oaths or codes central to the training, practice, or licensure of individual practitioners in social work, psychology, or medicine. Thus, in certain situations, employees may be left to choose between professional ethical obligations and their employment. One example, described by Frederic Reamer [1], concerns the administration of a juvenile correctional facility that requested staff social workers to notify the administration when a juvenile resident was found to be an undocumented

Strategies to strengthen the provision of mental health care at the primary care setting: An Evidence Map

“…In as much as hospital-based mental health care have been justified for years [24], the effect of strategies to strengthen the provision of primary health or community-based mental health care is supported by various levels of evidence. Some of the identified strategies on the EM have been recommended and endorsed for implementation by the WHO Mental Health Action Plan 2013–2020 [25].…”