Questions posed by APA Members, Components and Staff
What is your number one priority, and how would you work towards achieving that?
Serving the APA for 12 years on the Ethics Committee and the Assembly has acquainted me with significant concerns about scope-of-practice issues. Other mental health professionals with a fraction of our education and training are treating psychiatric patients without adequate breadth and depth of medical knowledge. As a seasoned clinician, I have personally seen significant misadventures as a result. I have helped craft and push for action papers and position statements on this issue in the Assembly — to use our collective strength to fight the fiction that we are replaceable by mid-level “providers” and psychologists. In my connections on social media with hundreds psychiatrists who do not belong to the APA, I’ve learned that our organization’s inadequate accomplishments on this issue is the foremost reason they have not joined. I have extensive experience with mainstream media (including host of a radio talkshow about psychiatry that broadcast to over 43 million listeners) and social media. These give me the connections and tools to help the APA better use the media to educate the public about the training and experience of psychiatrists and what constitutes appropriate and safe collaborative relationships with mid-level practitioners.
What is your position on affiliate membership for non-physicians? How will you advocate for your position within this organization?
I strongly oppose affiliate membership for non-physicians. I consider the APA not just a professional organization, but a covenantal community that guards and champions the special space of skill and values of physicianship in general, and psychiatry in particular. As a medical ethicist, I am acquainted with the venerable history of our profession and the values we have been “pro-fessing” and developing for over two millennia. Serving on the Ethics Committee for 6 years, I have worked with the APA Code of Ethics, which roots the APA in the groundwork of the AMA’s Code of Ethics for Physicians. There, I learned how our profession has unique aspects meriting our organization’s confining its boundary to physicians. Moreover, the perilous encroachment of other unsupervised mental health professionals into clinical activities for which they are inadequately trained, only adds to society’s confusion in discerning boundaries between us and non-physician practitioners. Affiliate membership will stoke that confusion. It would also dilute the clarity of APA’s advocacy efforts for psychiatrists. As a Board member, I would strongly advocate to the other APA leaders, publish pieces in member newsletters and professional tabloids, and inspire Assembly actions to retain the APA’s physician-only status quo.
From a member services perspective, what would you do to meet the professional needs of psychiatrists throughout their career from training to retirement?
I have a special interest in ethics and professionalism. I have lectured on ethics to DB’s and academic departments throughout the country, often including a teaching rounds on ethics and professionalism with the residents of these departments. Developing a sense of the fundamental ethos of medicine and psychiatry and learning how to systematically think through dilemmas — both have value that will percolate into a wide variety of professional needs throughout our careers. Besides the daily conundrums of individual patient care, larger questions will confront us as psychiatrists, E.g: effects of climate change on populations, immigration, gun violence, limitations on conscientious objection in healthcare, and growing legalization of assisted suicide (that will eventually touch our psychiatric patients). I would work to make training in ethics and professionalism more accessible to members, starting in residency, as well as at the annual meetings. An ethics section is needed on the APA’s online Members’ Learning Center. The APA Ethics Committee is an underutilized resource; its availability to answer questions and provide consultation needs more advertising to members. Open forums at the annual meeting to ask questions of senior and retired psychiatrists would be of great value, drawing upon their lifetime of experiences as seasoned professionals.
Tell us about your most important achievement
In 2015 I learned that in Belgium and Holland several hundred psychiatric patients each year are being legally euthanized, on request, for allegedly untreatable mental disorders — euthanasia that is often administered by the same exhausted psychiatrists who had previously been trying to prevent their suicides. As a psychiatrist and ethicist I was profoundly disturbed by this revelation. In my roles on both the APA Ethics Committee and the Assembly I worked with a colleague to craft and persuade the Board to approve a highly influential APA position statement — that it is unethical for a psychiatrist to deliberately prescribe or administer death to any non-terminally ill patient. I was able to get the APA, one of the largest and most important voices of psychiatry in the world, to say — “This is
not OK.“ Since then, I’ve been traveling and speaking to colleagues, legislators, and policymakers in 7 different countries, articulating the fundamental ethos of Psychiatry; explaining why psychiatrists should prevent suicide, not provide it. This is my most important achievement — so far.
Where does the profession of psychiatry need to be in five years?
A large percentage of us do not participate in insurance, due to inadequate reimbursement and heavy administrative burdens. Our profession needs to break through those obstacles to have our services covered in a more equitable way, that makes insurance participation more desirable for us.
There are many more people in need of psychiatrists than we can personally provide, due to these and other access issues, as well as our insufficient numbers. Over the next 5 years we need to be participating more as teachers, consultants, and supervisors to small and large healthcare systems, and leverage our expertise as leaders of state-of-the art, comprehensive medical psychiatry across the entire continuum of care. To do this, we need a strong 5-year plan to step up our message in the media and public education about who psychiatrists are and what makes our unique training and skill-sets effective, worthwhile, and deployable— in collaboration with other mental health professionals — but... not replaceable by them.
Tell us something about yourself that most people don’t know.
I was the host of a radio talkshow about psychiatry that broadcast to 43 million listeners, nationwide. I’d often speak on that show about how Hollywood movies misrepresent psychiatrists and psychiatry. My complaints came to the attention of Hollywood Director Bruce Beresford, who had won the Academy Award for Driving Miss Daisy. He contacted me to work with script writer Akiva Goldsman on a movie they were preparing to shoot, that featured two psychiatrists, played by Richard Dreyfus and John Lithgow. Not only was I able to help revise the script to convey more accurate portrayals of the psychiatrists and their work, but I also went to the film set, where I was invited to help direct Richard Dreyfus, John Lithgow, and Liv Tyler in 3 different scenes. This led to several other opportunities to help movie directors more accurately portray psychiatrists, including one with Steven Spielberg, and a small independent film, where, after being asked to consult on improving the script, I ended up playing the part of the psychiatrist in the movie!