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首页> 外文期刊>The Journal of Graduate Medical Education >The Administrative Psychiatric Evaluation
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The Administrative Psychiatric Evaluation

机译：行政精神病学评估

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Case Example Jenny?is a postgraduate year 2 resident in psychiatry with satisfactory rotation evaluations in the middle range of her class, with no incidents. One day, she is asked why she decided to become a physician. She states that she had major depressive disorder as a teenager, and she decided to specialize in psychiatry to help teenagers with similar problems. Her response is relayed to hospital management. Can the hospital request that she undergo an administrative psychiatric evaluation? Program directors sometimes request that a resident undergo an administrative psychiatric evaluation to ensure patient safety. Still, what are the laws that apply to these requests? The Americans with Disabilities Act (ADA) prohibits an employer from requesting psychiatric information from, or requiring a psychiatric evaluation of, an employee unless there is a reasonable belief based on objective evidence that the employee is unable to perform essential job functions because of a psychiatric condition; or the employee will pose a direct threat to safety due to a psychiatric condition. “Direct threat” is defined as a high risk of substantial harm to self or others in the workplace that cannot be reduced or eliminated through reasonable accommodation.1 A speculative or remote risk is not sufficient. These protections apply regardless of whether the employee has a disability. The example above and the questions and answers that follow illustrate these principles as they apply to the resident, Jenny, diagnosed with major depressive disorder, single episode, in full remission. Three additional case examples and further discussion may be found as online supplemental material. Question: Do the ADA laws apply to Jenny if she is no longer depressed? Answer: Yes. The ADA protects all employees against unwarranted medical inquiries and examinations, regardless of disability or history of disability. Q: Can the hospital require Jenny to undergo an administrative psychiatric evaluation? A: No. Jenny's evaluations indicate that she is able to perform the essential functions of her job, and there have been no incidents to suggest otherwise. The mere fact that she had a major depressive episode as a teenager does not provide the hospital with a reasonable belief that she is unable to perform essential job functions because of a psychiatric condition. The assumption that she might pose a direct threat to patients as a result of impaired judgment from depression is based on stereotypes and broad generalizations about her condition rather than objective facts about her current performance. Even if Jenny is currently experiencing a major depressive episode, to justify an evaluation, the hospital must have direct evidence that she is unable to perform essential job functions, or that she poses a direct threat as a result of that episode. Q: Could Jenny's program director “advise” her to undergo an administrative psychiatric evaluation? A: No, not if there is any expectation that the hospital will receive the results, request the results, ask her follow-up questions, or learn whether she underwent the evaluation, or if the evaluation is to be performed by an agent of the hospital. In addition, it may be reasonable to construe “advice” from a director as a disguised order or request. Q: Is an administrative psychiatric evaluation in Jenny's best interests? A: No. Referrals for administrative psychiatric evaluations are generally coercive,2 are not confidential,2,3 and request sensitive information from mental health providers. By violating the confidential therapeutic relationship, they can seriously compromise mental health care.4 The evaluations also cost a minimum of $4,500 for the resident.2;Case Example Continued Jenny's program director requests that she undergo an administrative psychiatric evaluation. Jenny is afraid that the evaluation will be used as a “fishing expedition” to discover and/or distort evidence in order to remove her from the progra
机译：案例示例珍妮？是在精神病学中居住的研究生第2岁，在她的班级中系列的令人满意的旋转评价中，没有事件。有一天，她被问及为什么她决定成为医生。她指出，她作为一个少年患有重大抑郁症，她决定专注于精神科，帮助青少年有类似的问题。她的回应是将医院管理层中继。医院可以要求她接受行政精神病学评估吗？方案董事有时要求居民经历行政精神病评估以确保患者安全。尽管如此，适用于这些请求的法律是什么？残疾人法案（ADA）禁止雇主请求雇员的精神病信息，或要求雇员的精神病评估员工，除非基于客观证据，员工因精神病学不到必要的工作职能而有合理的信念健康）状况;或者员工会由于精神病的情况而对安全进行直接威胁。 “直接威胁”被定义为在工作场所中的自我或其他人的高风险，无法通过合理的住宿减少或消除.1投机或远程风险是不够的。无论员工是否有残疾，这些保护都适用。上面的例子和问题和答案，如下说明了这些原则，因为它们适用于居民，jenny，诊断出患有主要的抑郁症，单一集，全面缓解。可以发现三种额外的案例和进一步讨论作为在线补充材料。问题：如果她不再沮丧，ADA法律适用于珍妮吗？答：是的。 ADA保护所有员工免受无名的医疗查询和考试，无论残疾或残疾史如何。问：医院可以要求珍妮进行行政精神病评估吗？ - 答：不，珍妮的评价表明，她能够履行工作的基本职能，另外还没有意见。只要她作为少年拥有一个主要抑郁症的事实并没有为医院提供合理的信念，因为由于精神病的情况，她无法执行必要的工作职能。假设她可能对抑郁症受损的判断患者对患者构成直接威胁的是基于刻板印象和对她的病情的广泛概括而不是关于她目前表现的客观事实。即使珍妮目前正在经历一个主要的抑郁症，为了证明评估，医院必须有直接证据表明她无法表现出基本的工作职能，或者她因这一集而导致直接威胁。问：珍妮的节目总监“建议”她接受行政精神病学评估？答：不，不是如果医院会收到结果的任何期望，请求结果，询问她的后续问题，或者了解她是否接受评估，或者如果评估是由代理人执行的医院。此外，可以合理地将导向器的“建议”作为伪装的顺序或请求来解释。问：是珍妮最大利益的行政精神病评估吗？答：不可以。行政精神病学评估的推荐一般是强制性的，2不是机密，2,3并从精神卫生提供者提供敏感信息。通过违反机密的治疗关系，他们可以严重妥协心理保健.4评估也为居民至少花费4,500美元;案例例子仍在继续遵侧珍妮的计划主任，她接受行政精神病学评价。珍妮担心评估将被用作发现和/或扭曲证据的“钓鱼探险”，以便从寄生中移除她

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