Legal Corner: Determining what information to disclose when receiving referrals from physicians
Every year, the APA Practice Organization hosts a Practice Leadership Conference (PLC) in Washington, D.C., bringing psychologists from Canada, the United States and its territories together to hone their advocacy and leadership skills. During this year’s PLC, the attorneys in Legal & Regulatory Affairs convened a town hall meeting to answer some of the legal challenges faced by psychologists*. Audience members were invited to submit questions in advance, as well as ask them on the spot. This is the second of several issues of “Legal Corner” that will feature a question from the forum that has broad impact.
Integrated care: Consent
Q: My group practice receives referrals from pediatricians and primary care physicians. We are often contacted by the referring medical office before the first visit inquiring about the appointment date and time. What are we able to disclose prior to meeting with the patient and obtaining written informed consent? This seems to be standard practice among medical professionals who make or receive referrals.
A: Medical practices don’t always realize the heightened protections required for mental health services, so communicating with them is crucial to avoid misunderstanding. As a matter of fact, a common complaint from physicians is that they often never hear back from psychologists after referring patients to them. By not communicating, the psychologist not only thwarts future referral opportunities, but also hurts patient care. This is your prime opportunity to begin a collaborative relationship. So, how can you communicate with other providers without violating patient confidentiality?
If you are not expecting a referral from a particular source and receive a call like this, you should first let the referring medical office know that you cannot discuss patient information, including whether the patient has made an appointment, without proper informed consent. You could then assure them that you will obtain this consent when you meet with the patient and report back to the medical practice within 48 hours of the visit. Make sure you follow through.
As you begin to receive regular referrals from certain physicians — or would like to — you could create your own informed consent form for them to use. The form, which will be signed by the patient in the physician’s office, should be worded to permit you and the referring provider to talk to each other about the patient’s care, including if the patient fails to make the first appointment with you. You can agree to a protocol where the medical practice will fax the form right away so that you can feel comfortable talking to them without worry.
If the medical practice is not interested in handling extra paperwork, you could ask if they would be willing to have the patient make the appointment with you from their office. You (or your staff) can obtain verbal permission from the patient to talk to the physician before your initial visit. Of course, you will then confirm this in writing when the patient sees you.
The result of open and prompt communication will be improved coordination of care for the patient, and a solid trusting relationship with the referring providers.
Disclaimer: *Legal issues are complex and highly fact-specific and state-specific. They require legal expertise that cannot be provided in this article. Moreover, APA/PO attorneys do not, and cannot, provide legal advice to our membership or state associations. The information in this article does not constitute and should not be relied upon as legal advice, and should not be used as a substitute for obtaining personal legal advice and consultation prior to making decisions.