Psychiatric malpractice: some aspects of cause.

The legal concept of malpractice is rooted in the issue of negligence. Liability and duty are related matters which bear on the doctor-patient relationship. The quality of the doctor-patient relationship appears to be the crucial factor related to the emergence of malpractice claims in general medicine and surgery and also in psychiatry. Two methods for assessing negligence are described and their limitations discussed. An alternative concept of a "malpractice threshold" is proposed. This threshold is derived from the arithmetic product of two variables (risk and doctor-patient rapport) which, when exceeded, triggers a patient response in the form of a lawsuit. Brief clinical examples are provided. Review of a large number of psychiatric malpractice cases may permit quantification of these variables. The identification and study of such factors is a rational step toward the prevention of incidents which may give rise to claims of malpractice.