Working with patients

Advice to new patients

Prior to the initial consultation with a new patient, psychiatrists in private practice should inform the patients about the:

likely length of the first and subsequent consultations
options for special needs, such as the support of family/carer(s)/advocate(s) and/or access to an interpreter
need to arrive early to complete forms
fee structure and charges, including upfront fees and terms and conditions around any cancellation and failure to attend fees
preferred methods of communication with the practice.

General information may be provided verbally and/or in writing. Psychiatrists may wish to consider developing an information brochure that explains the nature of their practice and what patients can expect at their first appointment.

Refer to:

What’s a psychiatrist? (information for patients)
New patient information sheet template [MS Word; 24 KB]

Financial arrangements with patients

Psychiatrists must be open and honest, and respectful of others in all their financial arrangements. In all financial arrangements with patients psychiatrists should:

seek informed financial consent from their patients for any procedure or treatment that will be performed, including likely out-of-pocket expenses, prior to treatment
consider their patient’s ability to pay and act in their patient’s best interests when making referrals and/or providing or arranging treatment
manage situations when a patient is unable to continue to afford paying fees, such as exploring with the patient whether negotiation of an alternative mutually agreeable fee is an option. When this is not an option, a psychiatrist should refer the patient back to their general practitioner or referrer, where relevant.

Refer to:

Members with a financial interest in a treatment or management facility

Informed consent

Informed consent is an individual’s voluntary decision about their medical care that they make with adequate knowledge and a clear understanding of the benefits and risks involved about the care. A psychiatrist should seek the informed consent of their patient before they provide medical treatment.

Australia

In Australia, a psychiatrist should be familiar with the National Health and Medical Research Council General Guidelines for Medical Practitioners on Providing Information to Patients (RESCINDED).

Aotearoa New Zealand

In Aotearoa New Zealand, a psychiatrist should be familiar with the:

Initial consultations

During the initial consultations, a private practice psychiatrist should inform the patient about:

the practice’s privacy policy
hours of availability and after-hours options
when relevant, discuss if and how the patient wants their family/carer(s) to be involved in their care.
their management plan including length and type of treatment, and when and how the psychiatrist will communicate with the patient, their GP, other health professionals and, if relevant, family/carer(s).

Clinical consultations

When undertaking a clinical consultation with a patient, a psychiatrist should:

recognise and work within the limits of their competence
respect a patient’s right to seek a second opinion
involve family/carer(s) appropriately
respect previous clinical contacts with other health care professionals and take care not to denigrate.

Refer to: MCNZ When another person is present during the consultation

General medical health

Poor physical health is very often associated with mental illness and vice-versa. Psychiatrists should liaise regularly with the patient’s GP and with other health professionals, as necessary. As part of their biopsychosocial training, a psychiatrist has a shared responsibility to support a patient in accessing adequate treatment for medical conditions, and to encourage a patient to receive such treatment.

Prescribing medications

A psychiatrist should prescribe medications within the scope of their clinical expertise. Attention should be given to informing the patient’s general practitioner about ongoing prescribing, to support overall medication management especially when a patient has co-morbidities. When informing patients about new treatment decisions, consideration should be given to also informing their family/carer(s), if relevant.

Refer to: MCNZ Good prescribing practice

Shared care

Shared care arrangements may be beneficial and appropriate for patients. Such arrangements may be between psychiatrists, or between psychiatrists and other health professionals and/or relevant agencies. The management of shared care in the community can be challenging in terms of defining roles and communication. Psychiatrists should clearly communicate their scope of clinical responsibilities for a patient to other health professionals involved in the care of the patient.

Refer to: Best practice referral communication between psychiatrists and GPs

Communicating with children and young people

Providing care or treatment to children and young people carries additional responsibilities for medical practitioners. When providing care to this age group psychiatrists should endeavour to have clear agreements in place with all parties, if possible, about:

family/carer(s) involvement and communication, including consent and privacy
management of risk
responsibility for payment of fees.

Engagement with families and carers

A carer is any person, including a family member, who provides support, assistance or personal care to a person with a mental illness, or a disability resulting from a mental illness. Carers play a critical role in the delivery of mental health services, and should be appropriately involved in care, whenever possible.

Mandatory reporting obligations in relation to children

Health professionals in Australia and Aotearoa New Zealand are required by law to report suspected cases of child abuse and neglect to government authorities. Psychiatrists should be familiar with the legislated mandatory notification requirements and reporting processes within their relevant jurisdiction and be aware that these vary between jurisdictions.

Refer to:

Cultural competency and safety

Recognition and accommodation of a patient’s cultural practices and beliefs is integral to a practitioner fostering a therapeutic relationship with the patient to optimise their mental and physical wellbeing. In the delivery of care, a private practice psychiatrist should be sensitive and responsive to their patients’ cultural needs and contexts. Cultural competency relates to people of culturally and linguistically diverse backgrounds including Aboriginal and/or Torres Strait Islander and Māori peoples. Cultural safety is an outcome of the way that health practitioners’ practice and requires doctors to reflect on their clinical interactions and the care they provide to patients. In doing so, practitioners are able to reflect on how their own views and biases impact their decision-making and quality of care.

Use of interpreters

Interpreter services may be useful or even necessary to effectively communicate with patients and their family/carer(s) to overcome barriers relating to language, culture or disability.

A psychiatrist should assess the need for interpreter services when:

they have difficulty in communicating in spoken English with their patients from non-English speaking backgrounds
their patients or family/carer(s) speak little or no English
their patients or family/carer(s) requests an interpreter.

In Aotearoa New Zealand, a psychiatrist should recognise that the Treaty of Waitangi is the nation’s founding document. In doing so, they should acknowledge the centrality of the Treaty and apply the principles of partnership, participation and protection in the delivery of medical care.

Refer to:

Provision of services outside of consulting rooms

When undertaking a consultation outside of their own rooms, a psychiatrist should:

ensure that the patient’s privacy and confidentiality is maintained
ensure that the environment in which the consultation takes place is safe
explain to the patient about any limitations to the provision of care in this environment
ensure that the service, especially if conducted in the patient’s home, can be seen to be appropriate, from a boundary or safety point of view (e.g. maybe involve family/carer(s) too).

Telepsychiatry

A private practice psychiatrist who offers telehealth services should assess the clinical appropriateness of the patient for a telepsychiatry consultation. A psychiatrist should contact their Medical Defence Organisation (MDO) when a patient seeking telepsychiatry services is not located in a country in which the psychiatrist has medical registration. A psychiatrist should also provide their patients with sufficient information to enable them to make informed decisions about their care.

Working with community support organisations

When working with community based groups, psychiatrists should recognise the conflict of interest that can occasionally arise, between the needs of their patient and/or family/carer(s), and the needs of the community group.

Refusal of treatment

In accordance with the legal principle of self-determination a competent patient is under no obligation to undergo treatment. When a patient refuses all treatment after possible treatment options have been discussed with them, a psychiatrist should respect the patient’s right to decline treatment, but should accurately ascertain the patient’s competency, and record this in the clinical notes.

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.