Boundaries in care

[Attending1985]

I had a former colleague call me yesterday and ask me to see his wife. I’m very hesitant. What are others policy on this?

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[comp1]

Eh, no. I'm not saying this is necessarily a boundary crossing. It's definitely not a boundary violation. I'm just saying your gut is saying no, so say no. There are plenty of psychiatrists out there for people with cash or even good private insurance.

 

[calvnandhobbs68]

Do you know anyone else you think is good you could refer them to and give that person a heads up like "hey heres the situation can you do me a solid and see this patient?"

No firm policy on this cause this hasn't come up yet but I'd probably refer them somewhere else.

 

[Attending1985]

Do you know anyone else you think is good you could refer them to and give that person a heads up like "hey heres the situation can you do me a solid and see this patient?"

No firm policy on this cause this hasn't come up yet but I'd probably refer them somewhere else.

He framed it as a privacy issue. I no longer work at that health system and she works there as well. I really don’t have anyone else I could suggest.

 

[littlefred]

It puts you in a tough spot. What if you end up prescribing a controlled substance? A board complaint and investigation could mean trouble. I'd avoid this request like the plague.


I'd recommend your colleague get an online provider for his significant other. If there's no one else physically in the area. Plenty of online resources that can be found like for example on psychologytoday.

 

[Sushirolls]

Are you friends with this person? Would you ever use them as a reference? Or call to catch up?
If no, and your working relationship has truly ended and social relationship, too, then say yes.

But if you call, email, facebook, etc this person, or consider them friends, then say no.

Let both parties know that any perception of friends/colleagues they may have had, is now over, and calls/concerns should be directed through your normal office operating methods.

 

[Celexa]

Are you friends with this person? Would you ever use them as a reference? Or call to catch up?
If no, and your working relationship has truly ended and social relationship, too, then say yes.

But if you call, email, facebook, etc this person, or consider them friends, then say no.

Let both parties know that any perception of friends/colleagues they may have had, is now over, and calls/concerns should be directed through your normal office operating methods.

I agree with this. It can be insanely hard to find a good psychiatrist. If you have a relationship with the person or their spouse independent of work that'd be a reason to decline. But if it's a professional referral what's wrong with saying yes and treating them as a patient like any other?

 

[whopper]

Options:
1) No. It is the easier and cleaner thing to say no.

2) Yes-why?
I've been in this situation several times. I've had patients I've gotten better, and then it turns out they have several siblings with the same exact problem, and the same med helped (not surprising given pharmacogenetics).
I used to always say no when family members asked me to take in their family member. I reneged on that stance because in several areas I worked there was no other psychiatrists, (or more specific to my case the only other one in that town I worked in was literally on top of a dive bar/strip club-seriously, and no surprise he was a terrible psychiatrist), and I've literally had cases where for over 2 years the patient told me they got better with treatment, but the main problem was that their family member wasn't getting help, so this caused them to worry.

Bringing in family members did, however, inevitably bring in the boundary crossing problems. Most cases no, but some yes. The typical cases were a couple where I saw the husband and wife, but later marriage problems developed. I'd tell the couple they need to see a marriage counselor.

I always start off with a "if I take in your family member there could be boundary problems," and bring this up with the new patient/family member, and if this happens I will refer one or both to another physician. I also tell them I'm only doing this because there's a shortage of psychiatrists and this could be less than ideal, and they have to understand and agree with it.

 

[calvnandhobbs68]

Options:
1) No. It is the easier and cleaner thing to say no.

2) Yes-why?
I've been in this situation several times. I've had patients I've gotten better, and then it turns out they have several siblings with the same exact problem, and the same med helped (not surprising given pharmacogenetics).
I used to always say no when family members asked me to take in their family member. I reneged on that stance because in several areas I worked there was no other psychiatrists, (or more specific to my case the only other one in that town I worked in was literally on top of a strip club-seriously, and no surprise he was a terrible psychiatrist), and I've literally had cases where for over 2 years the patient told me they got better with treatment, but the main problem was that their family member wasn't getting help, so this caused them to worry.

Bringing in family members did, however, inevitably bring in the boundary crossing problems. Most cases no, but some yes. The typical cases were a couple where I saw the husband and wife, but later marriage problems developed. I'd tell the couple they need to see a marriage counselor.

I always start off with a "if I take in your family member there could be boundary problems," and bring this up with the new patient/family member, and if this happens I will refer one or both to another physician. I also tell them I'm only doing this because there's a shortage of psychiatrists and this could be less than ideal, and they have to understand and agree with it.

OP is not saying it's a family member of a current patient though, it's the wife of someone he knows personally/professionally is what it sounds like. Way messier than seeing a family member of one of your patients.

 

[FlowRate]

I had a former colleague call me yesterday and ask me to see his wife. I’m very hesitant. What are others policy on this?

Decision would depend on a couple main factors for me:
1. How close of a (former) colleague? Any likelihood of future interaction beyond coordination of care?
2. Are you in a small town with few psychiatrists or a big metro with tons? (Or somewhere in between?)
2.b. Are you one of few docs outside of healthcare system that take their specific insurance?

I saw a therapist colleague's husband as a patient. I'm not close with that therapist but do interact with her rarely. I had never met her husband before. He needed to see someone in our system and I was actually one of the docs in the clinic who she was least close with (newest doc in the clinic/most of the other docs already knew her husband socially.) She had transitioned to a role where she was no longer in our clinic so it's not like there would be future work function reasons to see her+her husband, either.

I also have seen other physicians in the system as patients, since there are few psychiatrists outside of our system who take our insurance. I would somewhat consider them colleagues since I occasionally have to interact with them to coordinate care of mutual patients (they're all non-psychiatrists.)

 

[whopper]

OP is not saying it's a family member of a current patient though, it's the wife of someone he knows personally/professionally is what it sounds like. Way messier than seeing a family member of one of your patients.

This is certainly more complicated! This is in that gray area, but the shade of darkness is much more extreme than the examples I brought up above.

If I were in the situation I'd agree to take it only if every (edit-everyone) understood the boundary issues at risk, there were no other options, or all the other options were bad.

 

[TexasPhysician]

Is this a former colleague that you consider a friend or want to spend quality time with vs a former colleague that you may have never wanted to contact unless regarding a shared patient?

I’m fine with treating family of former colleagues that I don’t plan to spend quality time with.

 

[comp1]

There was a time when you could use the argument that there are no other good psychiatrists around. It's kind of narcissistic on the surface, but I'm sure it was true in select extraordinarily rural areas. This is no longer a viable argument. Psychiatry is practiced very well through telehealth. You're essentially now arguing there are no good psychiatrists in the state if you make this argument. The more I've thought about this, the more I'm inclined to just really clearly have the OP say no and recommend telehealth. I definitely second the above that the absolute best solution for family members and others tangentially related to the field of mental health practice to avoid complex dual relationships is to have them see a practitioner hundreds of miles away.

 

[clausewitz2]

There was a time when you could use the argument that there are no other good psychiatrists around. It's kind of narcissistic on the surface, but I'm sure it was true in select extraordinarily rural areas. This is no longer a viable argument. Psychiatry is practiced very well through telehealth. You're essentially now arguing there are no good psychiatrists in the state if you make this argument. The more I've thought about this, the more I'm inclined to just really clearly have the OP say no and recommend telehealth. I definitely second the above that the absolute best solution for family members and others tangentially related to the field of mental health practice to avoid complex dual relationships is to have them see a practitioner hundreds of miles away.

I'm not sure you need to go to this extreme. I think seeing the non-nuclear family members of someone you know professionally is not necessarily a problem. However, I do think you subsequently need to pretend when speaking with the person related to the patient you have another relationship with that the patient does not actually exist in the world. But then I give good non-reactive deadpan, so I can see how others would not find this adequate.

 

[annoyedpsychiatrist]

If you have no social relationship with the person, then personally I would do it if in your shoes. Ive had similiar situations happen to me multiple times where ive agreed to take the person on as a patient. The rule I set though would be that I have no kind of social relationship with the person nor plan to in the future. If you dont know the person personally and dont plan to become involved in their personal life, then I dont see any reason to say no. Its hard to find a psychiatrist in many areas, and even harder to find a good one.

That being said, this also can be quite stressful, because there is a personal element, and you feel more responsible for how good/bad theyre doing. That part can get tricky. Could be good to get a little more info before you agree to see them.

 

[lol.psych]

On the small off-chance you’re looking for an excuse to avoid spending any future social time with the former colleague, this could be a dream come true…

But on a serious note, it probably isn’t a great idea. Is there any reason you’re the best clinical match (e.g. she has super hard to manage OCD and you’re the top OCD specialist in the region, or she needs TMS and you’re the only practical/accessible TMS provider, or something like that)?