You are judged on process, not outcome: assess within the standard of care and document it. The big traps are patients who keep refusing your recommendations, agreeing to ineffective treatment without warning, being one stop in a chain of urgent benzodiazepine prescribers, and loose boundaries, so keep strict rules and get supervision or risk management involved early.
What you are liable for
You are liable for a process, not an outcome. You are not expected to be right, and no one can be right all the time; follow the standard of assessment and treatment planning, and document it.
“What you're ultimately liable for isn't an outcome. It's a process. So what you need to be doing is that you need to be actually doing your assessment process within the standard of care and also documenting it”
56:35Suicide Risk Assessment: Acute vs Chronic Risk, Formulation, and Suicidal Ideation TypesJun 2026 Also said in 1 more episode
“That's really more important than being right, that you followed the correct process. You're not expected to be right. It's not possible to be right all the time. This is an imperfect practice. Humans are imperfect, but you need to follow the standard of assessment and treatment planning”
58:26Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025 Courts and society love to hold clinicians accountable, even for things outside their control. That is why we recommend following some pretty strict rules and boundaries.
“the courts and society love to hold clinicians accountable OK, even for things that are outside their control. So because of that, my recommendation, my personal recommendation is that you follow some pretty strict rules and boundaries”
50:45When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 People think psychiatrists can predict the future, have special insight into people and can save them from suicide or keep them from harming others. It is not true.
“They think we're these magic men, magic men and women who can predict the future and have special insights into people and all of that and that we can protect people, we can save them from suicide, we can keep them from harming others. It's not true”
30:58Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025
Common traps
A patient who repeatedly refuses your treatment recommendations is a liability bomb. And if you cannot reach an alliance and get them to go along with the plan, you are not helping anyway.
“If a patient is repeatedly refusing to follow your treatment recommendations, that is a liability bomb. And to be frank, if you're not able to confer with that patient, reach a therapeutic alliance and get them to go along with it, then you're not helping anyway”
1:02:36Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 If you offer or agree to an ineffective treatment and do not warn the patient about that, you are liable if something bad happens.
“If you offer or agree to an ineffective treatment and you don't warn that, then you're liable if something bad happens”
1:03:45Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 Do not agree to be the stopover in a series of doctors a patient visits for urgent benzodiazepine prescriptions, even under the urgency of apparent withdrawal.
“You should not, even under the urgency of apparent medical withdrawal, agree to be the stopover in a series of doctors that a patient is going to for urgent benzodiazepine prescriptions”
26:08Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025
Boundaries and transference
When a patient's feelings toward you escalate in plain medication management, refer back repeatedly to the treatment frame and the plan. If it gets to that point you are in hot water, and you should begin calling risk management.
“Refer back repeatedly to the treatment frame, to the plan, and do whatever you can. To be honest, if it gets to that point for just a plain medication management, not for a psychotherapy, you are in some hot water, my friend, the clinician, and I would begin to call your risk management”
39:11When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Unless you have a very clear idea of what you are doing, seek supervision.
“Unless you have a very clear idea of what you're doing, I highly recommend that you seek supervision”
33:53When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 Malpractice insurance may specifically exclude coverage for "mishandling the transference," a disguised way of saying having sex with patients.
“malpractice insurance might specifically exclude coverage for mishandling the transference which actually is a uh disguised way of saying having sex with your patients”
34:11When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025
From these episodes
- Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026 · 2 points
- Suicide Risk Assessment: Acute vs Chronic Risk, Formulation, and Suicidal Ideation TypesJun 2026 · 1 point
- Handling Difficult Situations in Psychiatry: ADHD Evaluations, Benzo Requests, Disability Claims, and Involuntary AdmissionsOct 2025 · 1 point
- When Patients Fall in Love with their Psychiatrist: Sex, Boundaries, Frame, and LiabilityAug 2025 · 4 points
- Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025 · 2 points
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.