In general, a person is required to report criminal activity and to appear and
testify as a witness if requested by the defendant or the state. This creates a
conflict of interest with a patient's expectation that a physician will
preserve the confidences of the physician-patient relationship. This conflict
is most acute for psychiatrists: their physician-patient relationships are
critically dependent on trust, and their patients are much more likely to
discuss matters such as criminal activity with them. There are explicit
protections for the psychiatrist-patient relationship, except as necessary to
protect the lives of third persons (see Chapter 8). The law also ignores,
without necessarily explicitly protecting, the nonpsychiatric physician-patient
relationship. This means that a physician can be forced to divulge information
if the police believe that it is necessary to prevent or investigate a crime.
This does not happen often, but it does happen.
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