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