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.