Whether engaging in treatment directly or assessment for the purpose of facilitating treatment, clinicians in a doctor-patient relationship assume an empathic, trusting and nonjudgmental stance with their patients. The patient’s perception of his or her circumstances is primary and the clinician advocates for the patient by using professional expertise to relieve the patient’s suffering. Forming a therapeutic alliance is critical for treatment to be successful. Clinicians also assume they share the same goal as their patients, which is optimal health and functioning. Therefore, the patient’s self-report is frequently the primary if not only source of information the clinician relies upon for diagnosis and treatment planning. Confidentiality restrictions limit further assessment (or corroboration) of reported symptom picture and level of functional capacity.

If a clinician is asked to testify in a legal matter on behalf of the patient, there are limitations to the type of testimony that can be offered because of the existence of a doctor-patient relationship. The clinician may testify as a fact witness, but should not offer expert opinions, unless extreme circumstances warrant it, such as the inability of the attorney to find an expert due to living in a remote area, etc. As a fact witness, the clinician can offer facts about when the patient was seen, general evaluation procedures employed, diagnosis, treatment protocol details and duration, prognosis, etc. The clinician should not offer [expert] testimony about issues indirectly related to the patient’s case, such as the empirical basis for tests employed, treatment protocol chosen or prognosis. They should similarly not opine about psycholegal matters, such as injury causation, competency, sanity, recidivism risk or fitness for duty. In doing so clinicians risk having their full testimony stricken, not to mention damaging the therapeutic relationship. Attorneys who consider using their client’s treater as an expert witness, or who send their clients for “clinical evaluation” in the interest of shortcutting, risk irreparable harm to their cases. By retaining an independent expert, attorneys can ensure that a treating clinician’s fact testimony withstands the scrutiny of the legal system and the therapeutic relationship remains intact.