The stresses created by malpractice litigation are very likely to affront the identity of psychiatrists as it does for all physicians, challenging their ethics, clinical competence, and compassionate regard for patients. These challenges often dwarf in concern the work entailed in the preparation required to manage the lawsuit. This experience by a clinician involves the disclosure in treatment of a patient’s abusive tendencies and actions that, following Tarasoff, resulted in lengthy high-profile litigation. The duty to work in treatment with a patient and maintain confidentiality can be at odds with the duty to protect society. How do we bear the distress when a patient discloses desires to abuse others? How do we think and feel about it? What do we do? See “When Duties Collide”
Commentary by Paulina Reiss, M.D.