Split treatment means a sharing of authority and control over patient care, meaning a loss of autonomy for each clinician. There is a widespread perception therefore that split treatment is associated with significantly greater risks (Macbeth, 2001).
What are the sources of legal exposure? There is potential liability for all psychiatrists who prescribe psychotropic medica-tions, see patients with depression and anxiety, especially those patients with severe disorders, and treat patients with significant suicide potential. Further, informed consent is an important area of concern.
Since patients are shared in split treatment and it is dif-ficult for clinicians to communicate with one another, there is ample opportunity for there to be a rise in missing information, miscommunication and a decrease in quality of the doctor– patient relationship. Patients are usually seen less frequently by the physician in a split-treatment relationship and the patient is of-ten not clear whom to call in certain emergency situations. Fami-lies are usually seen by one of the clinicians, not both. Sometimes there is a supposition that the therapist is being supervised by the physician when the physician believes the relationship to be col-laborative rather than supervisory. Macbeth offers the following risk-management strategies:
· Psychiatrists should familiarize themselves with the opera-tions and routines of all practice settings. The psychiatrist must be knowledgeable about the expertise and authority of those involved in care management.
· The most problematic practice sites should be weeded out. Issues include looking at staff turnover, peer review proce-dures and credentials of key staff members. The psychiatrist should find out about opportunities for consultation and staff interaction, system immunities and insurance of nonphysician clinicians.
· There must be careful coordination with therapists who have greater access to patients. The psychiatrist must inform the therapists what information the psychiatrist needs; when she/ he needs to be told about changes in the patient’s symptoms and condition, and the strengths and weaknesses of the ther-apists. The psychiatrist must inform the therapist about the medication regimens (potential side effects). This information must be updated regularly.
· Psychiatrists must understand the system review and ap-peals procedures to be able to act quickly when there are problems.
· Either consultation or supervision schedules should be set up and documented regularly to review specific patients.
· Personal assessment of individual patients must be set up with reference to her/his condition, status and treatment.
· Psychiatrists should be extremely careful not to issue an insur-ance policy to a managed care organization or other system. All proposed contracts must be carefully reviewed and not used to indemnify by accident.