Friday, March 13, 2009

We Don't Say.

Here and there, now and again, people have come on to the blog or written in to our temporarily dormant My Three Shrinks podcast and asked for our opinion on clinical matters. Scenarios are described and questions are asked about the specifics of treatment or side effects. Our unified response as blogger-psychiatrists has been to not respond.

It's not that we're ignoring anyone and it's not that we don't have thoughts or opinions, but there's a lot going on here, and it's really not possible to say much with only part or one side of a story. More cogently, it's not that we don't care about anyone's concerns, questions, or distress. It's simply very clear: We can't respond. It is unethical for us to express medical opinions, tantamount to medical advice, on a patient we have never examined and to render those opinions in a public place.

There's a rule in psychiatry known as the Goldwater Rule-- this could be a ClinkShrink post, she knows all this stuff. The Goldwater Rule is based on a section of the The Principals of Medical Ethics of the American Medical Association that reads:

Section 7.3

On occasion psychiatrists are asked for an opinion about an individual who is in the light of public attention or who has disclosed information about himself/herself through public media. In such circumstances, a psychiatrist may share with the public his or her expertise about psychiatric issues in general. However, it is unethical for a psychiatrist to offer a professional opinion unless he or she has conducted an examination and has been granted proper authorization for such a statement.

And why is it called The Goldwater Rule? From a 2007 article in Psychiatric News,

Ethics Reminder Offered About 'Goldwater Rule' on Talking to Media

This passage is referred to as the "Goldwater Rule." How did this eponym come about? A presidential column by APA's 126th president, Herbert Sacks (1997–1998), explains its origin:

"We are reminded of the 1964 Goldwater-Johnson election, when 1,189 American psychiatrists responded to an inquiry for their opinions of the candidates by a now defunct magazine [Fact magazine]. The bulk of the political responses, couched in psychiatric terminology, were so unfair and so outrageous to Goldwater that he sued and won a substantial settlement. APA issued public statements decrying such analyses and in 1973, when The Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry were drafted, Section 7.3 stated [see above]."

Dr. Sacks also noted in his column, "Psychobabble reported by the media undermines psychiatry as science." His words remain true today.

When commenting on individuals in the public eye, psychiatrists should be governed by concerns for the potentially inflammatory and harmful consequences of their statements. The reputation of the public figures involved, their own credibility, and the dignity of our profession are at stake. Only after performing an examination and receiving an appropriate waiver of confidentiality should psychiatrists comment on persons in the light of public attention.

But it's just a question and you're not a celebrity and you're not the subject of media attention! Oh, but our blog is public and it seems prudent to observe the standards of our profession that dictate what it is or is not appropriate for us to comment on.


Anonymous said...

I found this post very interesting!I always wondered why some of the news shows psychiatrists discussed these issues in such general terms. I had no idea that it isn't ethical to hypothesize about a celebrity's ailments.

Anonymous said...

Now, if only they could stop media laypersons from giving pseudo-psychological profiles of people they've never met. Hacks like Nancy Grace make me want to scream.

Rachel Cooper said...

What about situations like Dr. Drew or Dr. Phil or other celebrity "shrinks", who don't treat people per se, but consult publicly on people's problems. What do you think about professionals in those types of roles?

Anonymous said...

Hmmm. I've only watched Dr. Phil once and he was talking about being from Texas and I'd never even heard of Dr. Drew.
Doesn't Dr. Phil have the people he's advising on the show? If they are there face-to-face to talk and answer questions, then whatever it is, and my sense is it's entertainment and not treatment, then the Goldwater Rule doesn't cover it. Even if he's giving advise about how to deal with a spouse that isn't on the show, it's still a simulated therapy situation. If he's actually commenting on the psychological makeup of celebrities he hasn't examined, it's not cool. However, the Goldwater Rule and the stuff we quoted are from the AMA Ethics, and since Dr Phil is not an medical doctor, this particular stuff doesn't apply to him. I'll assume that psychologists have their own standards of ethics, and I'm not familiar with those, so I can't comment on them.
Wasn't there some public issue about Dr. Phil and Britney?

eln-- I think that's called Freedom of Speech. Shrinks can do that, too, at parties, with their friends...but it's just a person with an opinion...not a public statement with the 'expert' label attached. It may be okay to do it publicly as long as there's no "M.D." or reference to the speaker being an expert/a psychiatrist/ or a representative of a medical community. I'm not sure of that, but I think if you're a shrink walking down the street and a report shoves a microphone in your face and says "What to you think of So&So?" and the shrink namelessly replies, "I think his policies are nuts and he seems unstable" .... I think that's okay... as long as it isn't couched as Dr. Genius, the expert psychiatrist's, medical opinion on the mental status of So&So. Maybe Clink has something to add, I'm not sure about the fine points here.


Anonymous said...

I have this mole that looks a little atypical. I was wondering if you guys could take a look?

The Silent Voices in my Mind said...

How (if at all) does this apply to dead famous people? I'm not talking about guessing what Heath Ledger was thinking. What specifically came to mind is the theories I've heard/read that Albert Einstein had Asperger's Syndrome. How does that type of activity fit in with the Goldman Rule?

Anonymous said...

Thanks for the legal advice (ah, irony).

I suppose I should have worded it like this...
Now, if only people would stop paying attention to the pseudo-psychological profiles of media laypersons, thereby denying them the platform that elevates them far above "just a person with an opinion."

On the other hand, I DO have a problem with people like physiologist Dr. Laura calling herself a "licensed psychotherapist" when giving her opinions, when she holds no such license (she usually says "licensed therapist" on the publicly owned airwaves, but with a clear intent to gain credibility and import through deception).

Moving on, frankly I was going to say that many mental health professionals seem to blithely ignore the Goldwater Rule, but I couldn't think of a good example. Your link provides an excellent one however; I recall seeing that over and over in the aftermath on TV and the internet. While I don't think it should be illegal, I am very pleased to see the APA actively discourages it.

Anyway, how does all this apply to the internet psychotherapy/CBT I think Clink mentioned a bit ago? Do they typically arrange in-person examinations to begin with or is it more lax?

Roy said...

Don't know about the internet CBT, but thought I'd offer my pseudorandom thoughts.

"licensed therapist": that's weird for Dr Laura to do that (or it is strategic). Health professionals are licensed by the state (there are as yet no federal-level professional licensing bodies), and someone who may be licensed as a "Licensed Clinical Professional Counselor" in one state may be referred to as something different in another. And the rules for licensure vary from state to state. But, I'm pretty sure no states have licenses for "Therapist", as that is too general a term. If a "media therapist" provides actual "therapy" on TV or radio or youtube or whatever, and if it does not comply with the standards of practice and the licensing standards (2 dif things) for that state, then one could file a complaint on that person in that state.

I recall reading that Dr Phil McGraw had resigned his license earlier in his TV career, possibly to prevent just such concerns. I suspect the the producers are careful to not put him in the position where he appears to be "practicing without a license". (Hmm, interesting read on Wikipedia.)

"thanks for the legal advice (ah, irony)": Exactly, lol. Funny how if one is in a profession, one has to be careful to establish the boundary between, say, lawyer advice and just average Joe Blow advice. But if one is not a "professional", then one doesn't need to be careful at all. That thoughtful carefulness is part of what defines a "profession."

Anyway, when someone asks for specific advice (eg, "I take Wellbuzac. Is that what is making my pee smell like ham?"), one way to handle this is to respond very generally, such as "Studies show that hamodorous urine occurred in 8% of Wellbuzac users, while it occurred in only 2% of placebo users." [props to doc_rob]