Prescribing Doctors' Roles

...Medicine is "the last repository of the truth of the human condition," and "the qualities of the good physician are inseparable from the qualities that make up the being of a real and authentic human being...

...Instead, in their final section, they choose to address the entire issue of malpractice, reciting familiar statistics about the rise in the number of suits and the increases in awards...

...Charles herself declared at the trial," I in some way had been left outside of something...

...The trial description, scarcely a prelude since it takes up over three-quarters of the book, is a genuine page-turner, not least because of the questions it raises about the law, psychiatry, and the relationship between the two professions...

...The complaint charged that she had failed to take Walker's depression and suicidal impulses seriously...

...The threat of a malpractice suit may bea clumsy, blunderbuss mechanism of control...

...The law, oddly, demands a similar view, categorizing psychiatry as a medical specialty like any other, and insisting on clear lines of responsibility...

...Nowhere else does treatment last an average of 10 years, and produce uncertain results...

...As one of his doctor-critics put it, "Has he ever seen half the children in an African village wiped out by a disease that could have been prevented by a simple vaccination...

...Given their experience, they have a right to be concerned, yet their remarks exude an aroma of special pleading...

...When he is not teaching philosophy, he lectures to doctors and medical students on the subject of "Human Values in the Practice of Medicine...

...Technology has so overwhelmed feeling and intuition that "the physician of today is only one-third of a physician...

...One imagines that his talks are extremely popular, for although he upbraids his audiences for their humanistic shortcomings, he places their profession at thecenter of existence...

...Writers & Writing PRESCRIBING DOCTORS' ROLES BY BARRY GEWEN Sara C. Charles and Eugene Kennedy had a specific reason for writing Defendant: A Psychiatrist on Trial for Medical Malpractice—An Episode in America's Hidden Health Care Crisis (Free Press, 230 pp., $17.95...

...He describes, for instance, a workshop in which he asked the doctors in his audience if they had ever seen a person die...

...A choice may have to be made between trust and truth...

...His approach, however, could hardly be more different from Charles and Kennedy's...

...And in his eagerness to affirm humanistic values, Needleman slights the accomplishments of science...

...After months of treatment, Walker, according to Charles, started showing signs of improvement, demonstrating self-confidence and a degree of independence...

...If she did not heal properly while under a professional's care, if, indeed, she ended up in a worse condition, there had to bea reason...

...The problem, as he sees it, is that doctors have sacrificed a quality of humanity essential to their practice for the dry intellectuality of science...

...The jury brought in a verdict of not guilty, for just about the only indisputable fact in this case was the plaintiff s injury...

...In fact, several stretches of The Way of the Physician feel as if they should be read with an organ playing in the background...

...She paid money to a doctor, and she expected a cure, as though her problem were as straightforward as a broken arm...

...A significant part of the argument for negligence rested on the fact that Charles, at no time during the 11 months of therapy, attempted to consult the hospital records on Walker's 1971 confinement...

...Charles, for example, refused to prescribe a powerful drug for her patient on the day she jumped...

...In short, without some kind of third-party verification, a doctor cannot be sure that he or she is getting an accurate picture from a patient...

...Needleman is a professor of philosophy at San Francisco State University...

...In trying to prove this point, the plaintiffs attorney may have had an impossible task...

...It is hard to make statements such as these without sounding like arather portentous preacher...

...Maybe it should not group psychiatry with medicine at all...

...A psychiatric expert for the defense who did examine them testified that they contained nothing which might have helped prevent the accident, but this is beside the point because Charles could not have known that...

...But to his credit, Needleman leavens his bombast with irony and occasional flashes of humor...

...In no other branch of medicine, though, is responsibility so obscure...

...In 1971, during her first year in college, she had been hospitalized for three months...

...But by October 1975 she was experiencing new crises, and on November 15, following days of frantic telephone calls to her doctor, her family in New York and her former therapist, she jumped from the roof of her apartment building, paralyzing herself for life...

...Elsewhere, the doctor/patient relationship is a minor part of the diagnosis and remedy...

...Fully expecting all of them to respond, "of course, countless times," he w as shocked w lien t he majority answered no...

...I had believed the things she told me about herself were what were really going on in herself...

...Jacob Needleman, in The Way of the Physician (Harper &Row, 187 pp., $15.95), is also concerned about the state of modern medicine...

...Charles and Kennedy do not pursue this line of thinking, or limit their attention to psychiatry's peculiar legal status...

...Their aim was to provide a detailed account of her legal ordeal as a prelude to a general discussion of the current inequities of malpractice suits...

...Needleman considers t his a scandal of medical education, since he believes that "for physicians, the experience of death is as necessary as the experience of wonder is for the scientist...

...They maintain that patients are absorbing the higher insurance costs, when there are no firm data on physicians' incomes and expenses...

...W hat is more, only foolish positivists would dismiss everything he has to say as Germanic nonsense...

...One conclusion that emerges fromDefendantis that the law should not be grouping psychiatry with other fields of medicine...

...he is her husband, a professor of psychology at Loyola University and a novelist...

...He wrote his doctorate on existential psychiatry, and his book is brimming over with Heideggerian terms like "authenticity," "care," and "Being...

...Experts for both the plaintiff and the defendant agreed that clinically she suffered from a "borderline personality disorder," making her unstable although not psychotic...

...They assert that malpractice suits are damaging healthcare, without offering any hard evidence...

...Would anybody dare to say if either or both of these incidents was a definite cause of Walker's act—or whether one was a more proximate cause than the other...

...A graduate student in clinical psychology in Chicago, Walker ostensibly sought psychiatric help to deal with problems she was having with her boyfriend...

...Thus, since the jury had to decide whether an unstable person with a borderline disorder could exercise "ordinary care for her own safety," the defense spent a good deal of time developing the dubious argument that Walker made a " rational" decision to kill herself...

...More pertinent was the expert's comment that looking up past records is not necessarily good psychiatric practice, for they can interfere with the one-to-one relationship of trust so critical to successful treatment...

...The malpractice section is a forgettable rehash...

...Psychological motivation is simply too complicated for the kind of mechanical cause-and-effect explanation the law requires (perhaps explaining why, relatively speaking, there are so few malpractice suits brought against psychiatrists...

...She is the psychiatrist of the title, who was sued for $10 million by one of her patients...

...On the other hand, the same witness observed that "therapists are constantly manipulated" by borderlines, who have "a great tendency to exploit other people...

...Still more perplexing, no doubt, was the issue of "proximate cause...

...Charles began seeing Terry Walker (a pseudonym) in December 1974...

...Yet they have done better and worse than they intended...

...Jurors were probably startled to learn during this presentation that a person who tries to commit suicide might not be considered " suicidal" an hour before the attempt...

...In bringing suit, Walker and her family were calling for a confidence in psychiatry that seems unwarranted...

...The physician must be at fault...

...Everything else was consumed in legal formalisms and psychiatric murk...

...That same morning, Walker's former therapist, whom she hadn't spoken to for at least a year, told her that she was much sicker than she thought...

...Psychiatrists, going back to Freud, argue over what is meant by "cure...

...Other doctors know when they have cured a patient...

...Charles was sued for negligence...

...At the trial, relatives testified that Walker had been confined because of severe depression, suicidal tendencies and at least one attempt on her own life...

...He is not afraid to play straight man in an exchange, and he tells one gruesomely hilarious story about a time when, as a young hospital orderly, he accidentally carried a severed leg onto a public elevator...

...The reality seems to be that Charles pursued wholly proper procedures as the profession defines them, but that psychiatry is not equipped to prevent suicide attempts like the plaintiffs...

...But if the profession has demonstrated anything over the years, it is that an instinct for self-protection prevails over all other interests...

...Fair enough...

...In his instructions to the jury, the judgeexplained that the plaintiff had to prove four things: that she was using ordinary care for her own safety, that she was injured, that the defendant was negligent, and that the defendant's negligence was the proximate cause of the injury...

...He is probably right...

...Unfortunately, at the present time, it is the only one we have...

...Here, it is the diagnosis and remedy...

...Most strikingly, they fail to examine the question of mistreatment by doctors, except for a few asides about self-policing...

...Only at the end of her third weekly session did she reveal that her troubles ran deeper...

...I'd trade all the spiritual teachings in the history of the earth for those lives...