Cynthia M. A. Geppert, MD, PhD

Cynthia M. A. Geppert, MD, PhD

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Like millions of Americans, I’ve joined Facebook. I really enjoy it because it conveniently lets me stay in touch with my friends. I don’t tell my patients that I have a Facebook profile, but many patients tell me about their Facebook activities during therapy. How should I respond if a patient to “friend” me?

I’m one of the only psychiatrists practicing in this area. What am I realistically supposed to do when I see one of my patients in public? Whenever I go to the gym or library or grocery store, I see several patients I’m actively treating. Some want to say hello and some want to socialize. My response so far has been to try to avoid them.

A number of scholars have criticized contemporary bioethics for its focus on what have been called the “neon issues”—end-of-life care, genetic technology, and resource allocation—rather than on the far less dramatic but much more common dilemmas of everyday practice, such as obtaining adequate informed consent for treatment, respecting confidentiality and privacy, and maintaining sound but reasonable boundaries in the therapeutic relationship.1-3 From the “searching and fearless” fourth step of Alcoholics Anonymous to the rigorous spiritual exercises of the Jesuits, many spiritual traditions have proposed a regular and deliberate period of introspection as an effective means of increasing the understanding of and responsiveness to ethical conscience and conduct.

The past several years have been a time of radical change in the economic, technological, social, and political landscape of our country. These developments, of necessity, affect education in all its forms—including continuing medical education. Increasingly, the print medium is becoming an endangered species and previously unimagined modes of information transmission, such as blogs, RSS feeds, and podcasts, have emerged as common forms of communication. The exponential growth of medical knowledge and the increasingly rapid pace of scientific discovery have made it nearly impossible for the print medium to keep abreast of new developments. The Internet has therefore become crucial as a source of up-to-date information to ever more intellectually overwhelmed clinicians. It is no wonder that many in medicine regard the Internet and its electronic affiliates with periodic ambivalence despite their enormous potential to catalyze adult learning.1

A 43-year-old woman presented to the ED at 5:30 am on a weekday. While being triaged, she indicated she was hesitant to speak with anyone. The patient reported to the consulting psychologist that she had been deployed to Iraq as reservist nurse 2 years earlier. During that time, an unknown assailant whom she believed to be an Iraqi national working with military security forces sexually assaulted her. The veteran confided that she had been too embarrassed and ashamed to report the assault.

A 24-year-old veteran of Operation Iraqi Freedom (OIF) presents to the ED mid-morning on a weekday. While the veteran is waiting to be triaged, other patients alert staff that he appears to be talking to himself and pacing around the waiting room. A nurse tries to escort the veteran to an ED examination room. Multiple attempts by the ED staff and hospital police—several of whom are themselves OIF veterans—are unsuccessful in calming the patient or persuading him to enter a room.

A 29-year-old veteran came to the ED complaining of headaches and uncontrolled pain in his upper quadrant. He had been discharged from the military after he sustained a blast injury during duty as a Marine in Iraq. His right arm had been amputated.

Since the time of Homer, warriors have returned from battle with wounds both physical and psychological, and healers from priests to physicians have tried to relieve the pain of injured bodies and tormented minds.1 The soldier’s heartache of the American Civil War and the shell shock of World War I both describe the human toll of combat that since Vietnam has been clinically recognized as posttraumatic stress disorder (PTSD).2 The veterans of Operation Iraqi Freedom (OIF) and of Operation Enduring Freedom (OEF) share with their brothers and sisters in arms the high cost of war. As of August 2009, there have been 4333 confirmed deaths of US service men and women and 31,156 wounded in Iraq. As of this writing, 796 US soldiers have died in the fighting in Afghanistan.3

Eastern philosophy and religion have always had what the philosopher Hajime Nakamura2 called “a preference for the negative.” This stands in stark contrast to our Western penchant for the positive, and our proclivity for defining and intervening is most pronounced in the overactivist mode of modern American medicine."

Recently, I was involved in a discussion with several other mental health writers and editors regarding the most appropriate term to use for those we treat: patient or client. Our lack of consensus reflected that in contemporary medical and psychiatric literature.


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