Medical professionalism

Personal relationships

Except for exceptional circumstances, a psychiatrist should avoid providing psychiatric care to themselves and to anyone with whom they have a close personal relationship, including family members, friends and work colleagues. Refer to:

Professional boundaries

Maintaining professional boundaries between a psychiatrist and their patients is essential to ethical and quality medical practice. A psychiatrist should never use their professional position to enter into a sexual, exploitative or otherwise inappropriate relationship with anybody under their care. This includes those close to a patient such as a carer, guardian, spouse, or parent of a child. Refer to:

Managing complaints and adverse events

Managing complaints is part of good practice. A private practice psychiatrist should have a complaints management process in place, which includes lodgement, assessment and follow up. The process, which may be written or verbal, should be communicated to patients.

Complaints and adverse events should be responded to directly and promptly. This may require an acknowledgement and an explanation about what happened and, if appropriate, an apology (a psychiatrist should also contact their MDO for advice). Refer to:

Reporting of alleged misconduct or abuse by a health professional

Psychiatrists concerned about alleged or suspected psychological, physical or sexual misconduct or abuse, or neglect, of one of their patients by another health professional may have a duty to inform the relevant authorities and the patient of their intentions/actions. Psychiatrists should be familiar with the mandatory notification requirements and reporting processes in their relevant jurisdiction.

Difficulties may arise where the patient does not want their psychiatrist to report the matter. In these circumstances a psychiatrists should seek advice from their MDO, and from expert colleagues.

Refer to:

Disclosure of conflicts of interest

A conflict of interest presents when a medical practitioner, who is entrusted with delivering care that is in their patients’ best interests, has personal, professional or financial circumstances, which may influence their patient care. When such circumstances compromise, or might reasonably be perceived by an independent observer to compromise, patient care, a medical practitioner must resolve the conflict in the best interests of their patient.

In dealing with conflict(s) of interest, or perceived conflict(s) of interest, a psychiatrist should:

Act in their patients’ best interests and never ask for, or accept, any inducement, gift or hospitality which may affect or be seen to affect the way in which they prescribe, make referrals and provide or arrange patient care.
Openly and formally declare conflict(s) of interest to patients when a situation has presented in which the psychiatrist’s interest could, or could be perceived to influence, patient care, and be prepared to exclude themselves from related decision-making.
When residing and working in a small community, consider how they will balance their duty to protect their patients’ right to confidentiality with social communication/relationships with patients, and patients’ relatives/friends, outside of professional practice.

Research

Research is vital to improve psychiatric care and treatment and the mental well-being of the population as a whole. When designing, organising or carrying out research a psychiatrist should always:

put the best interests and welfare of participating patients first
ensure an accredited Human Research Ethics Committee has approved the research protocol and that the research meets all jurisdictional regulatory and ethical requirements
adhere to the approved research protocol
ensure participation by patients is voluntary and that they have a good understanding of the purpose, methods, requirements, risks and potential benefits to them and to the wider community, and that they have signed informed consent to the research
respect the patient’s right to decline involvement in/withdraw from a study without prejudice.

National codes and standards

Codes and standards are designed to improve the quality of health services and to protect the public from harm. They function as mechanisms to determine whether appropriate measures are in place to ensure that minimum standards of quality and safety are met.

A range of organisations have prepared various national codes and standards for the delivery of mental health services in Australia and/or Aotearoa New Zealand. These documents are relevant to psychiatric practice and have been compiled for ready identification and access.

Medical reports, giving evidence and signing documents

Medical practitioners are entrusted by the community to sign various documents, such as death certificates and medico-legal reports, on the assumption that they only sign statements they know, or reasonably believe, to be true. In their delegated responsibility and authority to prepare and/or sign medico-legal documents a psychiatrist should:

act with honesty, integrity and objectivity
take reasonable steps to verify the content of the documents and only sign those they believe to be accurate
not write misleading statements, or deliberately omit relevant information
prepare or sign the documents/reports within a justifiable timeframe
state the limits of their expertise, where relevant, and not provide an opinion beyond those limits
explain any costs, which should be fair and reflect any required preparation time.

Advertising

Advertising of medical services may be useful for patients when seeking health care services.
Refer to:

Social media

Carefully planned participation in social media is an appropriate and effective mode of communication for a psychiatrist to connect with colleagues, educate the public about mental health, and advance the reputation and public profile of the psychiatry profession.

When a psychiatrist uses social media they should be mindful of maintaining confidentiality and professional boundaries with patients.

Dealing with the media

Psychiatrists have an ethical responsibility to maintain patient confidentiality and to provide information in an unbiased, evidence-based context in their dealings with the media. They should exercise caution and seek expert advice, as necessary, and respond according to the level of media handling knowledge they have obtained. Wise responses can be enormously valuable to patients, to the specialty, and to the community. Psychiatrists should consider contacting their local College Branch or the Tu Te Akaaka Roa - New Zealand National Office to assist in and/or contribute when a potential media opportunity presents.

Health and wellbeing of psychiatrists

Good health and wellbeing relate to fitness to practice and are essential for private practice psychiatrists. Psychiatrists should be mindful of their own physical and mental health and exercise self-care accordingly.

Refer to: Self-care for psychiatrists

Teaching and supervising

The delivery of teaching, supervising, assessing and mentoring to medical students, trainees, medical practitioners and other health care professionals in private practice settings is integral to their professional development and to the quality of care of patients. Teaching and supervision requires the psychiatrist to explain psychiatric assessment and treatment clearly and to properly understand the rationale for decision-making, which may aid self-reflection and self-awareness and enhance a private practice. A private practice psychiatrist should provide sufficient oversight and feedback to colleagues, medical students, trainees and other health care practitioners while simultaneously meeting the clinical needs of their patients.

Psychiatrists considering establishing a training post in their private practice for trainee registrars must first have the post accredited by the RANZCP. A psychiatrist should contact their local RANZCP training committee or RANZCP Head Office for information on trainee post requirements.

Continuous Professional Development

Maintenance of CPD contributes to high quality care and involves and undertaking exercises and activities that enhance the entire practice. Currency in Continuing Professional Development (CPD) is a requirement of medical registration in Australia. Psychiatrists in solo private practice should recognise the importance of participating in a peer review group and in practice supervision.

In Aotearoa New Zealand all practising doctor must be enrolled and actively engaged in a recognised recertification (i.e. CPD) program. Refer to:

Practice visits

Practice visits are a confidential, peer support exercise that provide an opportunity for both the host psychiatrist and the visiting psychiatrist to review, reflect on, and potentially improve, the way in which they work.

In appraising or assessing the performance of a colleague, a psychiatrist should:

be honest and objective, including with those whom they have trained or supervised
provide accurate, constructive, relevant and justifiable information when writing reports or giving references
be aware that patients may be put at risk if they describe a colleague as competent when, in fact, they have not reached or maintained a satisfactory standard of practice.

About this information

For enquiries about this information, contact policy@ranzcp.org.

Disclaimer: This information is intended to provide general guide to practitioners, and should not be relied on as a substitute for proper assessment with respect to the merits of each case and the needs of the patient. The RANZCP endeavours to ensure that information is accurate and current at the time of preparation, but takes no responsibility for matters arising from changed circumstances or information or material that may have become subsequently available.