Psychiatric trainees facing their medical liability: Results from the 2014 nationwide AFFEP survey

Abstract

IntroductionIn the past two years in France, four psychiatrists were charged or condemned for manslaughter relating to their practice with dangerous psychiatric patients escaping mental health care facilities. Facing this increasing litigation of psychiatry, the French federation of psychiatric trainees (AFFEP) set up a survey in order to assess the concern of its members of being sued, the consequences of this apprehension on their medical practice and their theoretical instruction on law and legal action risk.MethodsAn online survey was submitted by email to all the AFFEP members nationwide between the 2nd April and the 31st October 2014.ResultsEight hundred and thirteen responses were obtained (65% response rate). Regarding the concern of being sued for their medical practice, 85% of psychiatric trainees dread legal pursuits. This apprehension is significantly higher amongst female trainees (P = 0.004). Legal risk assessment is involved in the medical decision process of 89% of psychiatric trainees. This trend is significantly lower amongst trainees with previous legal teaching during their residency (P = 0.02). Concerning theoretical instruction, 62% of psychiatric trainees rates it insufficient and 28% non-existent during their academic training; 96% of psychiatric trainees want to make this theoretical instruction mandatory.DiscussionThe fear of legal pursuit is well known in psychiatry [1,2] but this study reveals that it begins as early as residency. In France, one explanation can be that psychiatry is the second most sued medical specialty in criminal court [3]. Specific theoretical training in law seems to be a solution in order to decrease the toll taken by legal risk assessment in daily practice.ConclusionConcern about legal action is very high amongst psychiatric trainees and the consequences of this fear impact their day-to-day medical decision process.