Psychotherapy, Atypicals-and Physical Contact?

January 16, 2010

You have prescribed an atypical antipsychotic for a patient who is undergoing psychotherapy. You need to check for signs of the metabolic syndrome with a physical exam. . . but is it ethical to touch the patient for this clinical purpose? Listen to ethicist Dr Cynthia Geppert examine the issues in her series “Living the Questions: Cases in Psychiatric Ethics.

I’m a psychiatrist in private practice and do not have a secretary or nurse. One of my patients who has bipolar II depression is undergoing psychotherapy. I have prescribed an atypical antipsychotic for this patient. The drug’s manufacturer recommends periodic checks for metabolic syndrome-which means (among other things) checking the patient’s blood pressure, weight, and BMI via measurements of his waist circumference.

I am willing to weigh patients undergoing psychotherapy and check their lab test results and blood pressure, but I am uncomfortable making physical contact to check waist circumference. Instead, I discuss with patients how to take care of themselves, and refer them to a primary care physician.

Is it appropriate to touch such patients for clinical purposes? If not, could I be blamed if a patient has an MI secondary to high blood cholesterol levels if I haven’t been monitoring these parameters?

Does touching a patient in this setting constitute a boundary violation?

We invite you listen to this podcast, in which ethicist and psychiatrist Cynthia Geppert, MD, PhD, tackles the ethical considerations. Dr Geppert is chief of consultation psychiatry and ethics at the New Mexico VA Health Care Center in Albuquerque. She is also associate professor of psychiatry and director of ethics education at the University of New Mexico.

Our thanks to Virginia Buki, MD, a psychiatrist in Aventura, Florida, who sent this case to Dr Geppert. If you are faced with an ethical dilemma, we invite you to submit the details to editor@psychiatrictimes.com.

Psychotherapy, atypicals - and physical contact?