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Corporate consulting offers variety, extra income. (No Doctor-Patient Relationships).

Providing psychiatric consultations to companies can provide a welcome change of pace and added income to office-based psychiatrists who are interested in the business world.

Psychiatrists who have made this part of their practice find few downsides to the work, but as Dr. Bernard S. Rappaport and Dr. Robert P. Gordon point out, it does present a number of ethical considerations absent in individual treatment.

Dr. Rappaport spends most of his time as a psychiatrist in private practice in Berkeley, Calif., but about twice weekly he receives a call from the Intel Corp., a multinational microprocessor company with 85,000 employees. "Being the psychiatric consultant to Intel is like being the consultant for a medium-sized city," he said. "I get to deal with issues that wouldn't come up often in my practice."

Dr. Rappaport typically hears from the company's occupational health nurses, their human resources legal team, or, in the case of workplace violence, one of the company's workplace response teams. He rarely deals directly with troubled employees; instead, he advises the company on psychiatric issues and, if necessary, refers the employee to a local psychiatrist for evaluation or treatment.

Much of his work involves advising the company about whether an employee may have a bona fide mental disorder and is thus covered by the Americans With Disabilities Act. Employees may allege that their claustrophobia prevents them from working in one of the company's ultraclean rooms wearing a "moon suit," for example. Dr. Rappaport also deals with issues of inappropriate behavior, such as sexual harassment or threats of violence.

Dr. Gordon, a psychiatrist and psychoanalyst in Chicago, has a somewhat different kind of consultation practice. While Dr. Rappaport works alone and is the principal consultant for a single company, Dr. Gordon works with a group of three other analysts who go from project to project and from company to company.

"Our particular expertise is being able to understand how unconscious agendas interfere with performance in business and performance in organizations," says Dr. Gordon. "The dynamic point of view--emphasizing unconscious forces, conflicts, issues of self-esteem, and things like that--is absolutely pivotal in all that we do. Those factors are tremendously important in how organizations function."

Dr. Gordon describes one case in which a company brought him in to meet with an executive who apparently had a drinking problem and had also recently become argumentative, defensive, and unwilling to listen to disagreement. After interviews with the executive as well as with several other upper-level managers within the company, it became obvious that the problem went deeper into the organization than this one person s drinking problem. Unconscious motivations within these other managers were preventing them from implementing needed organizational changes and from dealing with the problem employee in a rational way.

"A lot of times people will hire psychiatrists because they've designated in the organization or system one person as being the patient, the root cause of the problem," says Dr. Gordon. "In situations like that there's often a tremendous amount of resistance in getting people to understand that they're dealing with a systems problem that involves several different people."

In doing workplace consultation, it's important to keep certain ethical considerations in mind, says Dr. Richard D. Milone, chair of the American Psychiatric Association's ethics committee and medical director of St. Vincent's Hospital in Westchester, N.Y "I think it's commendable that a number of companies are willing to recognize that a psychiatrist has valuable expertise," says Dr. Milone, "but it has to be clear to the employee that in that role the psychiatrist is really the company's agent. He's not the doctor."

Although the psychiatrist can certainly be solicitous to the employee and give advice, it must be made clear that no doctor-patient relationship is being established and no medical care offered. The psychiatrist must also make it clear to employees that their relationship will not be confidential--that very likely the psychiatrist will report his clinical findings to the employer.

"What if what's in the company's best interest is not in the employee/patient's best interest?" asks Dr. Rappaport. "That's where I have to straddle the fence. I don't want to say or do anything that is harmful or not in this individual's best clinical interest. On the other hand, I want to be helpful to the company and find a way to resolve [the issue]. If I experience a dilemma, I look for a way that's going to be a win-win."

Dr. Rappaport and Dr. Gordon both charge a higher hourly rate for company consultations than they do for seeing individual patients.

Dr. Gordon says this makes up for the fact that such consultations tend to be less time efficient than office work. Dr. Rappaport says that he currently charges $250 per hour, more than he charges his individual patients but less than he charges lawyers for medical-legal work.

Several organizations can help the psychiatrist who aspires to enter this field. The Academy of Organizational and Occupational Psychiatry for example, maintains a speakers' bureau that can help in getting psychiatrists known among human-relations professionals.
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Article Details
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Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jun 1, 2002
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