The Rhode Island Board of Medical Licensing found that Dr. Goldstein engaged in unprofessional conduct when he referred a female patient to a white witch. She had been seen on a weekly basis for psychotherapy with Dr. Goldstein for approximately 15 months when he allegedly began to believe that a spirit was disturbing his patient's relationships. Dr. Goldstein facilitated a meeting between the patient and the witch and participated in a three-way telephone conference. The patient complained to the Board of Medical Licensing. An investigation ensued, and the Rhode Island Psychiatric Society [RIPS] provided its expert opinion to the board that the conduct of the anonymous psychiatrist was unprofessional. A consent agreement was entered into between the Medical Board and Dr. Goldstein, wherein he agreed his conduct was unprofessional and accepted sanctions.
Dr. Goldstein next found himself tangling with his own professional association. At the RIPS' request, the Medical Board notified the complaining patient that an investigation was being launched. She contacted the association, her complaint was pursued, and Dr. Goldstein was notified about a hearing date. The doctor objected to the investigation, and his argument that the RIPS should be precluded from conducting a hearing about his alleged misconduct traveled as far as the Supreme Court of Rhode Island. The court held that the RIPS had not become a party to the Medical Board's proceedings by rendering an expert opinion, and therefore the doctrine of res judicata did not apply to prevent the new proceeding. The court allowed the RIPS proceeding to go forward.
Editor's Note: The Medical Board informed The Echo that Dr. Goldstein has not renewed his license to practice medicine in the state of Rhode Island. His attorney refused to comment.
 | Michael Welner, M.D. Chairman The Forensic Panel |
Dr. Welner comments: What is supposed to happen within the psychotherapy? Therapists are trained with emphasis on different techniques, but therapists make very personal choices in what they say, and how they say it, what they do, and even what they recommend.
The gulf between rigorously researched "western" medical science and alternative interventions, including spirituality, remains in education only. When physicians and therapists move on to treating patients, however, they must heal at the level the patient can relate to. These are well-appreciated concepts in cancer and AIDS care, and accepted and supported at the highest levels of organized medicine. Even cardiac surgery units are incorporating alternative medicine philosophies into hospital patient care.
One is reminded of the psychiatrist Scott Peck, whose books have been helpful to thousands. Many regard him as something of a pop therapist; the exchanges don't reflect an orthodoxy of approach. His accounts of treatment, however, are particularly real in their descriptions of what happens between therapist and patient. Yet, in People of the Lie, Dr. Peck speaks of referrals to exorcists for treatment of what he most unscientifically defines as "Evil." Is this malpractice?
There is no consensus in the mental health community about the utility of different alternative treatments. As essential as they are to the credibility of psychiatry, confusion is created by the overreliance of the law community on DSM IV and the manuals of treatment standards. This implies that if conditions are not in DSM IV or if treatments are not approved by the American Psychiatric Association, they do not exist. This ignores the obvious that everyone is different and we share only a number of qualities with each other. Patients open enough to engage in psychotherapy are often open to alternative medicine, and are increasingly expecting us physicians to be, too. And why shouldn't I, as a psychopharmacologist, know more about melatonin than what I read in Newsweek?
What does a therapist then tell a treatment unresponsive patient she wishes to help, whom she knows and understands on human and not merely diagnostic terms?
I can't help you
You don't want to get well
There is no cure
The treatments have been shown to work in about 30 percent of a research sample
I'm sending you to a professional who has another treatment to offer We all face this dilemma. I am reminded of the continued debate about the value of thyroid supplementation in treatment resistant depression. I've tried this in approximately fifteen treatment unresponsive patients, with one probable response. Yet, numerous studies suggest this intervention helps between 20 and 40 percent of such patients. I can't help but look for the number of that white witch.
Psychiatry, psychology, and medicine have well-established and effective treatments. But as long as people die, we confront the limits of our medical knowledge. Our patients just want to get well expeditiously and painlessly; the standard of care in the real world is to achieve that end, with science, with standards, and when necessary, with creativity.
