Whether you’re a staunch Fox News viewer or you herald Rachel Maddox on MSNBC, I think most of us agree that Trump’s approach to serving as the leader of our country has been a unique one.
There are the twitter posts. There’s the way he says “China” like “vagina.” I think he needs a better way to self tan. And his rhetoric is definitely unprecedented.
Even if you voted for him, swallow your pride–it will go down–and come on…you know you agree there have been reasons to question his methods–whether you agree with them or not. He’s a unique guy. He’s different. For my Riverdale fans: he’s a weirdo. I think most leftists will definitely agree and I think the rational right side agrees as well. The issue is: does his administrative “uniqueness” pose a threat to our country? Or is it benefiting our society, our citizens, and our position in the world?
Here’s where the psychiatrists have come in to vocalize their opinions–whether we’ve asked them to or not. But is this appropriate? Does this violate medical ethics? Can you diagnose someone with a disorder who you’ve never even met let alone professionally examined in your HIPAA-protected office?
People love diagnosing other people. Whether or not they’ve got that MD. People don’t know what they don’t know. And it gets frustrating.
But people who know maybe too much–too much for one person–oftentimes put themselves above others; they think they have earned the responsibility to lead or must lead since they’ve been given the responsibility of an MD.
But MDs should know better than to hand out armchair diagnoses as easily as a Starbucks Frappuccino. And that’s exactly what a group of them did last week.
There’s something called “The Good Samaritan Law” in medicine. If you’re an MD and you’re on vacation in probably someplace like Maui sipping a Mai Tai and trying to correct your Vitamin D deficiency from the endless days stuck inside a sterile, emotionally vacant building. And a toddler, who can’t swim even though they very well could if taught, slips and falls into the pool–no one notices for several minutes until he’s rescued from the cement bottom of the deep end and laid onto the pool deck, as if it’s a stretcher, next to perfectly aligned lawn chairs, holding visitors bathing in the sun’s rays. And the brave soul who dove to rescue this toddler from the oxygen-deprived waters to bring him back into the molecularly perfectly balanced atmosphere that sustains human life, begins to panic when the boy lays lifeless like a deflated raft, without movement or breath. And the brave rescuer, after unsuccessful attempts to remember any CPR training–if they ever received any–fails to compress the chest hard enough–hard enough to break the tiny boy’s ribs–and administered breaths lacking the correct rhythm of compressions to mouth-to-mouth oxygen administration, one human to another. And finally screams for a doctor–or anyone with medical training–yelling “is there a doctor here? A nurse? We need help here!”
If you’re an MD you have two options: ignore or respond. If you do the first, and later without intention, someone discovers you do have an MD and you didn’t respond–either because you’re a shitty human or because you’re afraid because emergency medicine isn’t your specialty and you haven’t done CPR in years or you’re on vacation 4 drinks deep and can’t think straight–then you’re fucked. You could get called to the medial review board. Why didn’t you act. Why didn’t you practice that oath of beneficence (doesn’t matter if that toddler isn’t your patient.)
Or you can be the decent human being you are, not just the decent MD, and act–it can go good or bad but at least your intentions were to save a life.
This is the Good Samaritan Law: any MD can try to help any individual in distress and regardless of outcome is immune to malpractice suits–essentially. This applies to non-MDs as well–you’re legally protected too.
Good Samaritan laws offer legal protection to people who give reasonable assistance to those who are, or who they believe to be, injured, ill, in peril, or otherwise incapacitated.
So how does this apply to this post: diagnosing Trump. Do MDs have a duty to speak out, to help, when they feel someone is in peril or a risk to others? Or is it unprofessional to diagnose someone with a disorder who is not your patient?
A fine line indeed.
This past weekend in New York City, 125 mental health professionals marched on Broadway to demand that Trump be declared mentally unfit and removed from office.
The American Psychological Association code of ethics states that mental health experts should never perform armchair analyses of persons with whom they’ve never met to conduct an in-person physician-patient evaluation.
Cornell University psychologist Harry Segal, according to an article published by the New York Post, was reported as asserting, “we can spends the power of Trump’s underlying fear that he is worthless and weak by how intensely he resists and retaliates against any criticism. No matter how minor,” Segal continued, “he can’t let anything go.”
Psychologist Michelle Golland agreed. “We’re actually suffering from his narcissistic personality. He has no empathy. You can feel it, the way he spoke about the San Juan mayor…She has PTSD and our president mistreats her. She is re-victimized. That is a narcissist.”
Free speech is one of our most fundamental rights as US citizens. Demonstration against injustices is paramount to our democracy. But, is denouncing the president from the position of medical authority, when one has nothing more than a mere casual observation of his behavior whether it be on TV or through social media, unethical and irresponsible? Or are these physicians adhering to the Good Samaritan Laws?
In 1964, a survey of psychiatrists found that almost half of the respondents believed GOP presidential candidate B carry Goldwater was mentally unfit to be president of the United States of America. The survey included many unequivocal quotes from licensed psychiatrists. Some declared Goldwater as a “dangerous lunatic,” “paranoid,” and a “counterfeit figure of a masculine man.” Other MDs described Goldwater as having an “impulsive quality” and others asserted emphatically that he was being “emotionally too unstable” and accused him of holding a “Godlike self-image.”
Take note. This is a significant precedent. While Goldwater lost the election, he did win his defamation lawsuit against the now-obsolete Fact magazine, which had published those responses and the psychiatrist survey. The president of the American Psychiatric Association labeled the entire incident as a “very public ethical misstep” and the APA moved to institute a code, known as the Goldwater Rule, which states that psychiatrists are to refrain from offering diagnoses of persons based solely on casual observation and nothing more.
Saturday’s psychologist march on Broadway is reminiscent of this incidence almost 50 years ago. While psychologists are not MDs, the same ethical principles must obviously apply. Their demonstration in a series of ethically dubious anti-Trump actions as members of the medical community must be evaluated.
In February, 33 mental health experts sent a signed letter to the New York Times warning of the president’s “emotional instability.” The letter read:
“We fear that too much is at stake to be silent any longer. The president’s words and actions reveal he has an inability to tolerate views different from his own, leading to rage reactions. Trump is attacking facts and those who convey them.”
Their offhand diagnosis is just that: an armchair diagnosis performed on a couch, without dialogue, observing the actions of someone, they do not know or have ever met or evaluated in-person, on TV.
So almost 50 years have elapsed since the Goldwater remarks. The ethical code established then, technically, applies only to MDs–not psychologists. Their extreme reaction to the rise of trump is justifiable; they have a right to express their thoughts, opinions, stance. That’s the First Amendment. But does the crossing of their personal opinions with their professional judgment constitute a violation of medical ethics? Or are they just practicing the Good Samaritan Laws? Of helping those in distress.
Once you diagnose someone outside the examination room you are breaking professional medical ethical codes–but, in fine print, this does not apply to MDs. Psychologists are not MDs. Psychiatrists are. The march was a march carried out by psychologists.
But, regardless of the technicalities, no mental health professional should hold the belief that they are responsible for diagnosing those who they have not privately, HIPAA-protected, during an in-person appointment, evaluated.
Trump may have a personality disorder–Narcissistic Personality Disorder or some form of a Cluster A Personality Disorder. He may be Bipolar. He may have impulse control issues. But it is not our responsibility, as citizens, to make that diagnosis. I personally do not believe his actions fall under the protections of the Good Samaritan Laws. We gain nothing, we do not benefit, as citizens or as a society by throwing diagnoses out to the TV from our armchair at home.
That evaluation, diagnosis, treatment–if needed–is the responsibility of Donald Trump’s personal physician or medical staff. And this applies not only to the president. No MD, or medical professional, has the ethical right to diagnose someone they personally have not evaluated in-person.
AND, importantly, if you do not have an MD, I apologize for my bluntness, but you have no right to diagnose anyone at anytime with any disorder or disease. Would you like your doctor to show up at your office and take over your job with no qualifications? I highly doubt you’d be pleased.
I’m sure you can guess my own position on Trump. But to avoid political discussion, which is not the point of this blog, I will not state my voting history or my political endorsements.
What I will adamantly state is that I endorse proper medical diagnoses made by qualified MDs, who not only completed 4 years of grueling medical school exams and evaluations, followed by endless days and nights of years in residency, in HIPAA-protected in-person evaluations and appointments. Not by psychologists. Not by university graduates. Not by PhDs. By MDs ethically.
The prognoses of armchair diagnoses is poor. There is little–if no–chance of success. Leave the diagnoses to the professionals: to the MDs behind closed doors.
LINKS
American Psychiatry Ethical Code
Pulling the Plug on American Medicine 