This report is a revision of
Vulnerable Patients, Vulnerable
Doctors (Council Report CR101, Royal College of Psychiatrists,
2002). Since that document was written, confidence in the conduct
of some doctors towards patients has been undermined and there has
been a re-examination of doctors’ regulation and the standards
expected of them. These standards – for example
Good Medical
Practice (General Medical Council, 2006) and
Good
Psychiatric Practice (Royal College of Psychiatrists, 2004) –
deal with the whole professional role of the doctor, whilst this
report focuses on the therapeutic relationship. It places greater
emphasis on the vulnerability of the patient rather than the doctor
and on the corresponding responsibility of the doctor to the
patient. It aims to clarify further the principles for the conduct
of good therapeutic relationships, and to provide more explicit
guidance where appropriate.
The report sets out the principles that
should underlie any therapeutic relationship, not with specific
therapies. As the relationship between a doctor and a patient is a
dynamic one, changing with time and circumstances, the balance of
the principles may change with it. The clinician must decide where
the balance of the patient’s best interests lies. Many of the same
principles also apply where the doctor is working with a couple or
a family, as well as for individual patients.
The principles should be part of daily
practice, because all patients are vulnerable, but some situations
create more vulnerability than others and in these the clinician
should be especially vigilant. While the document deals
particularly with how patients are to be helped and harm to them
prevented, it also recognises that the doctor is vulnerable in the
therapeutic relationship. The principles and accompanying text
contain guidance on how harm to doctors can be prevented,
psychological, professional or to the reputation of their
service.
Although the report is primarily concerned
with the principles of conduct of doctors towards patients, it
provides a description of how patient factors and organisational
context can also damage or strengthen therapeutic relationships.
Thus, the report can be read in part as providing guidance on how
employers should treat their staff and how patients should carry
out their own responsibilities.
Contents of the report:
- Introduction
- Principles of good practice in therapeutic
relationships
- Factors undermining the quality of the
therapeutic relationship
- Factors strengthening the therapeutic
relationship
- Case vignettes (11 varying cases)
- Appendix. Avoiding boundary violations in
psychiatric practice
- References and further reading