Medicolegal Issues in Clinical Practice: A Primer for the Legally Challenged

Deborah J. Wear-Finkle, a forensic and aerospace psychiatrist who consults and lectures on medicolegal issues, has produced an excellent as well as entertaining guide to a wide range of medicolegal problems confronting the practicing physician and other clinicians who share similar responsibilities. In the preface she emphasizes that this book is not a substitute for legal advice on practice issues; rather it is intended to assist the clinician in acquiring knowledge to navigate the increasingly complex interface of law and medicine. To this end she has succeeded admirably.

Medicolegal Issues in Clinical Practice begins with a brief discussion of ethics and its relationship to law, followed by 120 pages on potential infractions in the physician-patient relationship, most particularly medical malpractice, informed consent, the right to refuse treatment, confidentiality, end-of-life issues, and inappropriate relational concerns. Dr. Wear-Finkle covers the socioeconomic as well as the legal dimensions of tort law. She presents the material concisely and in a manner that identifies important concepts and outlines the major issues of what constitutes negligence and how standards of care are established.

This section is followed by a discussion of risk management and defensive medicine. Dr. Wear-Finkle devotes several pages to informed consent, particularly the central issue of competency to make decisions in both the medical care and research contexts. She discusses exceptions to informed consent and the legal importance of documenting the basic elements of the patient's consent.

Confidentiality of patient information has become a particularly troublesome area for the clinician in recent years. This book addresses a wide range of situations in which maintaining confidentiality while using modern technologies, such as answering machines and computers, is frequently overlooked. The exceptions to confidentiality of medical records are well outlined, including mandatory reporting requirements and duties to third parties, and the author discusses how to handle court-ordered requests and subpoenas.

One of the most practically useful sections of this book is the chapter entitled "Limiting Liability." Dr. Wear-Finkle discusses communication between clinician and patient, focusing particularly on the critical importance of good documentation for patient care and legal protection. She examines how corrections should be made to the medical record and the care that should be taken to write only necessary information about the patient, avoiding disparaging comments about other clinicians and avoiding ambiguous statements. The benefits of consulting with experts in other areas of medicine and of documenting the results of such consultations are given particular emphasis in this chapter.

The remaining issues covered in this book have to do with the system features of medical care—managed care; agency regulation; organizational concerns such as supervisory relationships, credentialing, and privileging, to name a few; and special concerns of specific medical specialties.

Medicolegal Issues in Clinical Practice in effect covers the waterfront of legal matters for the clinician. It addresses all the major legal issues, some in more depth than others, which we all need to understand in the current medical care environment. The book should be considered required reading for practicing physicians, residents in training, and other professionals who treat patients.

Dr. Tancredi is clinical professor of psychiatry at New York University School of Medicine in New York City.