Ethical and Malpractice Issues of Psychologists in Hospital Practice

With increasing frequency, psychologists are working within a hospital setting. The reasons are varied: patients must be hospitalized; opportunities exist to work with other healthcare providers; and insurance companies require hospital privileges as a prerequisite for reimbursement. This expansion out of the private office to the hospital not only creates a more challenging and rewarding practice but it also gives rise to new ethical and malpractice dilemmas for the psychologist.

One issue facing psychologists treating hospitalized patients is whether the hospital authorizes and allows the psychologist to properly carry out the professional tasks that are necessary to fulfill his or her clinical responsibilities and to ensure the welfare of the patients. In addition, psychologists practicing in hospitals must be aware of any gross negligence on the part of the hospital in its hiring and monitoring of employees, and psychologists holding hospital administrative responsibilities must be particularly careful to avoid such negligence.

Psychologists must be aware of the ethical and legal implications of a hospital's decisions regarding policies such as admission, resource allocation, length of stay, follow-up after discharge, and likelihood of readmission. Understanding a hospital's attempt to maximize revenues, a psychologist should ensure that their services are being properly billed and that they are in no way colluding in any unethical or illegal process, including the hospitalization of patients until their insurance runs out and then discharging them.

A psychologist working in a hospital should have assurance that the hospital provides clear, explicit, and sensible procedures regarding the clinical aspects of patient care that are consistent with the American Psychological Association's ethical principles and specialty guidelines. The lines of clinical responsibility should be sufficiently clear as to prevent a patient from slipping through the cracks.

Maintaining appropriate confidentiality can be difficult in a hospital setting, and the issue is not easily addressed. Records of hospitalization for psychological disorders become part of a patient's general medical record at the hospital and can end up in the hands of insurers and other third parties. However, certain confidentiality problems can be solved by improved hospital procedures. Hospitals should provide adequate security for patients' charts, including a prohibition against leaving them clearly visible to passers-by or maintained in an unlocked public area.

Many hospitals not only treat patients but they also act as training facilities for healthcare providers. It is necessary to ensure that adequate precautions are taken to ensure that the treatment needs of the patients are not compromised by the training needs of interns and residents. The assignment of a trainee to a patient hospitalized for psychological problems for a predetermined length of time can be destructive to the patient who has formed a relationship with the trainee.

Copyright 2008 LexisNexis, a division of Reed Elsevier Inc.