A recent public discussion following a tragic event has reduced a complex clinical reality to a simplistic narrative: Telehealth, psychiatrists, or psychiatric medications must be to blame.

That conclusion may feel satisfying in the aftermath of an incomprehensible loss. But it is not how medicine, causation, or accountability should be understood.

A postpartum patient who is unable to get out of bed may appropriately receive care by telehealth. Virtual visits can be a practical, compassionate, and standard way to maintain access and continuity, particularly during a period when leaving home with a newborn can be difficult. Telehealth is not inherently inadequate care, nor is an in-person visit automatically sufficient care. What matters is whether the evaluation, follow-up, safety planning, and escalation were appropriate for the clinical information, symptoms, and warning signs available at the time.

Postpartum psychosis is rare, severe, and rapidly evolving. It is an obstetric and psychiatric emergency that can emerge suddenly and may fluctuate over hours or days. Patients may minimize, deny, or be unable to recognize their symptoms. Some may appear organized during an encounter yet become acutely unwell later. This does not lessen the importance of careful assessment, urgent escalation when warning signs are present, or rigorous review after a tragedy. It does mean that hindsight should not be mistaken for what was reasonably knowable in real time.

A devastating outcome alone cannot establish causation or determine whether any component of care was appropriate or inappropriate. Those questions require a careful, fact-specific review of the patient’s history, available information, clinical assessment, communication, follow-up, and the systems in which care occurred.

Psychiatrists and other clinicians make medication decisions to relieve suffering, improve functioning, and reduce risk. In perinatal mental health, these decisions require individualized consideration of the patient’s symptoms, psychiatric history, response to prior treatment, pregnancy or lactation considerations, personal preferences, and the risks of untreated illness. Medication decisions should always be reviewed carefully when serious harm occurs, but it is neither accurate nor constructive to portray psychiatric treatment as an effort to control or manipulate patients.

We should also be cautious about treating screening tools as definitive answers. Screening is important, but no questionnaire replaces clinical attention. A patient may have a negative screen while appearing distressed, withdrawn, overwhelmed, sleep-deprived, or unable to articulate what is happening. Listening closely, asking follow-up questions, involving supportive family members when appropriate, and responding to what is observed in front of us remain essential parts of good medicine.

At the same time, public hostility toward clinicians can create its own risks. Physicians caring for complex postpartum patients may feel pressured to send every concerning patient to the emergency department, recommend hospitalization at a lower threshold, avoid telehealth even when it improves access, over-document primarily out of fear, or decline to care for high-risk patients altogether.

Those responses may not improve safety in every circumstance. They can increase unnecessary interventions, reduce access to timely care, and further strain an already limited perinatal mental health system. Most importantly, they can shift care away from the individualized, compassionate clinical judgment that patients need.

The answer is not to ignore failures when they occur. It is to examine them honestly, learn from them, and improve systems of care without turning grief into broad condemnation of an entire profession or mode of treatment.

We need better access to perinatal mental health care, stronger continuity between obstetric, primary care, psychiatric, and emergency settings, family education about warning signs, clear pathways for rapid escalation, and thoughtful safety planning. We need to support clinicians in asking difficult questions and acting decisively when risk is apparent. And we need to preserve the ability to provide compassionate, evidence-based, individualized care without allowing fear and hindsight to dictate every decision.

Tragedy deserves accountability when it is warranted. It also deserves nuance.

Rabia Cheema is a rheumatologist.