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Remember when doctors practiced medicine? TofuEmmy

Posted by Mary_Bowers on October 21, 2004, at 23:05:16

In reply to Re: I give. gardenergirl, posted by TofuEmmy on October 21, 2004, at 20:00:47

Whether or not Robert Hsiung's ongoing activities here are practice of medicine or not is a question that has not been tried. But there was a time when doctors practiced medicine in clinics, when people who needed residential care got it, and when psychiatric doctors directed self-help groups in clinical settings where *somebody* had to take ultimate responsibility for potential adverse outcomes that might result when patients were asked to lend each other support. The food chain, in those settings, led to an insurance firm that underwrote whatever risk clinics took in administering mutual self-help groups. The dynamic resulted in clients interests being considered by professional actuaries, who were trained to balance risks that participants or administrators might not fully understand, and to propose guidelines for avoiding adverse outcomes in the face of calculated risks.

Self-help has apparently been outsourced now, allowing clinicians to unburden themselves, or at least to try to unburden themselves, of the calculated risks they invite clients to take when directing them toward self-help groups. Clients are understandably nervous when they are at risk of loosing the only human contact they might get from a healing profession that has become more of a dispensing industry, and in which therapeutic human understanding is available primarily outside the purvey of professional experience.

It is understandable that some readers, in their fear of loosing the few non-chemical mental health services to which they have access, would think first of the worst possible outcome - that the group would be shut down and that a psychiatrist would loose his license. I dare say if a medical review board were to vote to yank a license, there would be strong evidence of failure to live up to professional obligations, so it would seem the risk he would loose his license is balanced by the fact that it would only happen if other doctors thought it necessary. More likely outcomes, if the Illinois professional standards presented above conflict with his practices, would be various reprimands or sanctions. An even more likely outcome is that attention to the standards under which he is operating a private practice offering internet peer support with no review by his professional peers will lead to changes in the way he interacts with his professional peers, perhaps eventually accepting their counsel in the way he administers this site, and perhaps causing him to accept lessons learned by his peers who operate other sites under the aegis of institutional guidelines.

As for civil action, such an outcome would only likely follow action by a medical review panel. Unless an advocacy group gets on board, which might result in unwanted baggage, few attorneys would take the case on spec, and few plaintiffs would dare risk potential countersuits. But what harm is there in considering the recourse available to participants in a group who often complain about psychological injuries resulting from poor administration? Is it harmful for mental health patients to consider and publicly discuss their civil rights?

It is worth considering whether Robert Hsuing would buy server space for self-help clients if he were not also buying for himself the professional prestige of controlling the project. Does he have enough confidence in any of his professional peers, anywhere, to allow them to share decision making power in a project to which he has donated money and professional service? If not, why not? Would he contribute the same measure of financial and personal resources to a foundation or established clinic that might be able to parlay his investment to gain further professional and technical assistance for clients in need of support and education, along with a greater degree of protection for the minority of participants who present symptoms of harm resulting from participation in the group?




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