Particularly in a small community, patients may want to avoid the social stigma of seeking mental health care by receiving it from their primary care physician—who may know them well enough to have some insights an unfamiliar specialist would not.
Deciding whether to recommend Avastin or Lucentis raises ethical issues. Should the public health consequences of using a far more expensive drug trump what the doctor thinks is best for the individual patient?
Writing a case study of a psychiatric patient may change the patient-physician dynamic even if the patient consents to be written about. And when the patient is a minor and consent must involve her parents, the process becomes even more complicated.
As courts continue to define the balance between a First Amendment right of free speech, the public's right to know, and protection of the private, physicians must take care to protect patient privacy in any publishing endeavor.