There Are A Lot Of Good Doctors Out There, But …

The above study was also reported in the Clinical Psychiatry News in March.  It had no funding, just an enterprising fellow in forensic psychiatry.  And her apparent mentor was Glen Gabbard, some of whose work I read when he was at Menninger.  One of the guys who is old enough that he has seen things.

I give them points on reminding the world of something it seems to have forgotten. There are people who qualify as doctors, who are taking care of patients, and who are trouble. The problems in the group studied, people who have “professionalism issues,” range from sexual boundary issues to gross incompetence and cover specialties that are not necessarily psychiatry.  The physicians studied are mostly Caucasian males, which comes as no surprise to me.

The physicians studied mostly have psychiatric diagnoses. Things that sound like any fairly competent psychiatrist could have diagnosed them. There was some kind of “rehabilitation” involved when they were in training, for the most part, so they went on and acted rotten anyway.

I have been, in the course of my career, on several different sides of this issue; never effective, because I do not think anyone has done anything about it.

First, back early in my own training (as a psychiatric resident) I can swear that I could isolate some folks who were at risk for trouble. They were, curiously enough, a couple of Caucasian males who had a sense of entitlement that made me crazy.  They would talk about the “power” that came with being a doctor.  They were both already in debt and doing an excess of “moonlighting” on the side, in order to catch up. Residency, after all, is not a financial windfall and certainly not the time to own your first Porsche, thinking you will pay it off with early practice. This guy was later sanctioned for boundary issues; he was seen dating a “borderline” patient.  Probably, they should have let him date her, I mean this woman, as many with her diagnosis, was so much trouble for all concerned she was punishment enough.  Of course she was gorgeous, and probably would have convinced him to buy another Porsche.

The youngest and only female faculty member usually gets the dregs, so I was once hit with “monitoring” a guy getting rehabilitated from a sexual boundary violation.  As far as I could tell, he was a not stupid person who had “hot pants” and a sense of entitlement.  I read all the references I could.  I did what I usually do; became excessively responsible.  His therapist (I did not think it a coincidence she was very attractive) did not seem terribly competent, so I functionally took over therapy.  He was past the (brief) part where someone had to be in the room with him, so he was on his word of honor and I think I was not totally useless, although it may not have been a coincidence that I was female, either.

Once I was interviewed as the medical director of a facility I considered too shady to work at.  It was all female, substance abuse mostly, and they didn’t care a fig about my background; more about the fact that I happened to be female. I asked, as I always do, what happened to the last medical director.  I was told that he had been convicted of raping a patient, but that I should not worry about him, as he had found a job in another state.

I had a patient, early in my career, who chose me because I was female.  She had post traumatic stress disorder and had been, I believe her story to be true, raped by her psychiatrist. The treatment was long and difficult, especially because the patient had been too traumatized by the psychiatrist to do the “reliving” of the trauma necessary to file a complaint.  The therapist was, it seemed to me, drawing this out.

The one and only time I was on a Medical School administrative committee, I had to vote on whether to re-institute a student physician who had already been suspended three times for detoxification from alcohol.  I thought this outrageous, and voted against.  Give him some time.  At least an independent psychiatric evaluation.  He could be “dual diagnosis,” with an underlying psychiatric diagnosis that was somehow sending him back to alcohol.  Nobody seemed to have checked. He went straight back to his training and I was the sole negative rote.  I remember with fright what the winning arguments were.
1. We have already spent a lot of money training him.  We are not going to give up on him now.
2. He belongs to an ethnic minority.  We need more doctors to serve his ethnic community; besides, they are the ones who will take reprisals if we do anything.
3. Just keep him in treatment.  AA does not cost us, and he gets free treatment from faculty.

I was working in a prison when I saw a colleague, a homosexual but unpartnered psychiatrist who at the time was on some sort of “diversion” program for drug and alcohol problems, palpate the muscles on a patient’s body too see how his muscle development was doing. Granted this was only “borderline” but I cared enough to tell the psychiatrist in question, who informed me that I worry too much and he does this sort of thing all the time.

As far as I know, every single one of the professional physicians or psychiatrists could meet criteria for diagnosis of a mental illness. All of them are still practicing, as far as I know.

Medicine has traditionally “protected” its own. I am not sure which figures to trust of the “official” studies about how much of the population is seriously mentally ill.  I have heard the 6% figure cited both here and in the U.K. Whatever it is, having the requisite intelligence to acquire and use the skills of medical practice is no safeguard, nor is anything else I can think of. None of the doctors I talk about would “look” or act crazy after a single visit.  A patient could not and should not be expected to tell the difference. There simply does not seem to be anybody else who can or will. In the study cited above, the problem physicians were not referred to psychiatrists. Reasons I have heard given for refusing to refer physician-patients to psychiatrists range from a general distrust of the psychiatric profession to a desire not to “demean” the physician in training.

In other words, you are not going to be able to recognize this kind of physician, nor is anyone going to do a bang-up job of fixing things.

I did not set out to write a horror-story, but I believe I have.