Nothing
could be further from the truth. The psychiatrist-patient relationship,
like a bundle of sticks, is not a clear-cut phenomenon. Just as sticks
may be added to or removed from a bundle without altering the existence
of the bundle itself, certain aspects of the psychiatrist-patient relationship
may be added to or removed from a given situation without affecting
the existence of the relationship.
The
largest "stick" in the psychiatrist-patient relationship "bundle"
is the act of prescribing/administering medication. That act alone is
almost certainly sufficient to establish a psychiatrist-patient relationship,
regardless of any other actions taken or not taken. In other words,
should you prescribe or administer medication to any individual, you
must assume that you are that individual’s physician, with all
the attendant obligations and liability.
Two
other "sticks" which may establish a psychiatrist-patient
relationship, or at least create a question as to whether or not such
a relationship exists, are billing for services rendered and informal
counseling. The presence of a bill for services rendered is not determinative
of a psychiatrist-patient relationship, as a psychiatrist may provide
services pro bono or decide to write off a bill for professional reasons.
Likewise,
the trappings of a formal office visit constitute a relatively small
"stick" in the psychiatrist-patient relationship "bundle";
therefore, the absence of a formal office meeting likely would have
little impact on the existence of a psychiatrist-patient relationship.
Rest
assured, however, that it is unlikely that answering general questions
in a social setting would be sufficient to create a psychiatrist-patient
relationship. Anything more, such as a general conversation that culminates
in a psychiatrist providing specific advice or recommendations, could
conceivably expose the psychiatrist to liability.
In
social situations, the psychiatrist being questioned should state explicitly
that he or she is not acting as the individual’s psychiatrist and
cannot make specific diagnoses or treatment recommendations. It is always
appropriate to advise the individual to see a psychiatrist for an assessment.
In addition, when approached in a social setting, a psychiatrist also
must consider the nature of any existing relationship with the individual
and the possibility of a conflict. It is unwise, and may be ethically
prohibited, to treat a friend, colleague, or family member.
