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Ethics and Psychology

Where ethics is more than a code
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Wednesday, October 12, 2011

Dilemma 6: Referral and Treatment Boundaries

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A psychologist receives a phone call from a well-known

internist in her area. The psychologist is involved in a busy
practice, specializes in treating eating disorders, and receives
only occasional referrals from this physician. The physician
wants the psychologist to treat his 17-year-old daughter, who
suffers with what he describes to be an eating disorder and
perhaps some Borderline Personality Disorder traits.

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The physician explains that he has been medicating her for

about four months with Prozac and Klonopin, once he
became aware of her eating disordered behavior. Because of
his status as a well-known internist, he does not want to
refer his daughter to a psychiatrist because he believes that
he can handle the medication piece of her treatment. He will
also pay for all treatment in cash, as he wants as few people
and organizations to know about his daughters issues.

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Feeling somewhat uncomfortable with the medication management issue, the psychologist
indicates that she will have to call him back after looking at her schedule. The psychologist
then phones you for an informal consultation. The psychologist expresses her concerns
about working with a patient whose father is prescribing medication.

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Are there any ethical considerations in this dilemma?

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What are the potential pitfalls in the scenario?

What are potential advantages in this scenario?
What are some of the suggestions that you may have for the psychologist about accepting or
declining the referral?

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What concrete steps might be important before calling the physician back?
Are there additional considerations for how to approach the referring physician when calling
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Labels: Boundaries, Ethical Challenges, Ethical Decision-making, Referral

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