In his column, Dr. H. Steven Moffic has established a new duty for treating psychiatrists (“To Drive or Not to Drive? That Is the …,” The Ethical Way, October 2007, p. 41).
He suggests that treating psychiatrists evaluate each patient's fitness to drive.
However, Dr. Moffic pays scant attention to the damage such a conflict of role or interest might have on the treatment relationship. He also fails to refer to the most relevant ethical precept from the American Psychiatric Association: “A psychiatrist who regularly practices outside his or her area of professional competence should be considered unethical.” (“The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry,” 2006 ed., http://www.psych.org/psych_pract/ethics/ppaethics.cfm).
Instead, he takes the position that the treating psychiatrist should perform even a questionably competent evaluation because “practically speaking, such information usually is difficult to obtain.”
On the other hand, a forensic psychiatrist is in a position to answer questions about disability, competence, capacity, and fitness with little or no conflict of interest. In fact, the forensic psychiatrist can do this in a way that leaves the treating psychiatrist's relationship with the patient unharmed.
The duty of a clinical psychiatrist is to diagnose and treat mental illness. The only well-accepted exceptions are the Tarasoff duty to protect, the duty to report physician misconduct, and the duty to notify authorities of child abuse.
There is no established exception “when you are reasonably sure of potential danger” arising from psychiatrically impaired ability to drive. There is duty to “fill out forms.” There is no duty to ensure that a patient can obtain a license to drive a motor vehicle, to practice medicine, or to fly an airplane.
If a duty to protect the public from drivers impaired by their medications or mental disorders has been established, Dr. Moffic should cite applicable statutory or case law.
Treating psychiatrists are no more qualified to perform “clinical assessments” of fitness for driving than to determine whether their patients should be permitted to own or use firearms, permitted to return to work, considered disabled, considered competent to make a will, or considered competent to stand trial.
Nor are they qualified to determine whether a patient is fit to procreate, raise children, or ride a bicycle.
All such assessments result in a conflict of role, if not a conflict of interest, which probably would interfere with the physician's care of the patient.
As long as psychiatrists like Dr. Moffic find it more expedient to just “sign the form,” lawyers, insurers, bureaucrats, and a host of other third parties will exploit this free and easy alternative to forensic evaluation with no regard for the resulting damage to the doctor-patient relationship or for the quality of the assessment.
Dr. Moffic asks, “What is the clinician to do?” when your patient asks you to “fill out a form.” The answer: Focus on treating the patient to the best of your ability and follow your instincts and the admonition of Nancy Reagan: “Just say no.”
H. Berryman Edwards, M.D.