Psychiatrist ~ Mental health unit ~ District Health Board ~ Diagnosis ~ Communication with colleagues ~ Second opinion ~ Rights 4(2), 4(5)

A 22-year-old woman complained about a change in diagnosis when she was admitted to a mental health unit. She had a long history of mental health problems, and had previously been diagnosed as having a major depressive disorder. Following his review of the woman, a locum consultant psychiatrist concluded that she was suffering from a "factitious disorder" (a condition in which a person acts as if he or she has an illness by deliberately producing, feigning, or exaggerating symptoms and amended his or her treatment accordingly).

The psychiatrist did not consult with all of the patient's clinicians prior to making the change. The patient was not in agreement with the new diagnosis. In addition, she requested a second opinion, which was not provided.

It was held that, by failing to discuss his change in diagnosis with the woman's usual clinicians, and by failing to obtain a second opinion, the psychiatrist breached Right 4(5). He failed to co-operate with his colleagues to ensure quality and continuity of services. By failing to document the reasons for his change of diagnosis, he breached Right 4(2). He did not satisfy the professional responsibility to keep clear, accurate patient records that justified the change in diagnosis.