Medicolegal Issues

Dear patients: Letters psychiatrists should and should not write

Current Psychiatry. 2023 December;22(12):11-15,21,24 | doi: 10.12788/cp.0416

References

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Integrate prior knowledge of the patient. No letter writing request exists in a vacuum. If you know the patient, the letter should be contextualized within the patient’s prior behaviors.

Stay within your scope

Given the various dilemmas and challenges, you may want to consider whether some letter writing is out of your professional scope.^14-16 One solution would be to leave such requests to other entities (eg, requiring employers to retain medical personnel with specialized skills in occupational evaluations) and make such recommendations to patients. Regardless, physicians should think carefully about their professional boundaries and scope regarding letter requests and adopt and implement a consistent standard for all patients.

Regarding the letter requested by Ms. M, you should consider whether the appeal is consistent with the patient’s psychiatric illness. You should also consider whether you have sufficient knowledge about the patient’s living environment to support their claim. Such a letter should be written only if you understand both considerations. Regardless of your decision, you should explain your rationale to the patient.

Bottom Line

Patients may ask their psychiatrists to write letters that address aspects of their social well-being. However, psychiatrists must be alert to requests that are outside their scope of practice or ethically or legally fraught. Carefully consider whether writing a letter is appropriate and if not, discuss with the patient the reasons you cannot write such a letter and any recommended alternative avenues to address their request.

Related Resources

Riese A. Writing letters for transgender patients undergoing medical transition. Current Psychiatry. 2021;20(8):51-52. doi:10.12788/cp.0159
Joshi KG. Service animals and emotional support animals: should you write that letter? Current Psychiatry. 2021;20(11):16-19,24. doi:10.12788/cp.0183