Doctor as patient

I applaud Robert Klitzman ’80’s willingness to be so vulnerable and to discuss the advantages of the physician’s knowledge of being a patient in terms of the development of empathy (Perspective, April 23). I have spent the past 15 years working as a psychotherapist and psychoanalyst in clinical settings and private practice. It is without a doubt that the greatest single asset in my training has been my personal experience as a patient.

Richard A. Friedman, M.D., a professor of psychiatry at Weill Cornell Medical School and frequent contributor to The New York Times on issues related to psychology, wrote a piece Feb. 19, 2008, entitled “Have You Ever Been in Psychotherapy, Doctor?” In this article, Dr. Friedman highlights the importance of the doctor’s empathy, based on personal experience as a vulnerable patient. He reports that the vast majority of current graduates from psychiatric residencies complete their training without the benefit of any personal psychotherapy whatsoever.

In the past, it was de rigueur that most, if not all, psychiatric residents undergo psychoanalysis as part of their training. This change is a disturbing and tragic turn of events and a sign of the times. Currently, neurobiology and psychopharmacology reign supreme. The insurance companies, including managed care, do everything to reinforce a move away from talk therapy for both patients and their doctors in the interest of the most cost-effective treatment possible, i.e., medication. Even in the state of California today, one is not required to have personal psychotherapy to become a licensed therapist, although there are some incentives to do so.

It is heartening to know that there are other voices crying out in the wilderness for the physician to “heal thyself” and to understand the importance of what it means to be a patient in order to be a good doctor.