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It was a shock to learn from the September 5 issue that Steven Miles, M.D., a prominent and outstanding physician, is the subject of a disciplinary hearing based on "an automatic presumption of impairment," solely because, in answering a question on his application for renewal of his license, he revealed to the Minnesota Board of Medical Practice that he had been treated for bipolar disorder.
Far from being impaired, Dr. Miles is described as having an unblemished record. He recently was named the outstanding gerontologist in Minnesota, as reported by Psychiatric News. He is known to me through his excellent work in biomedical ethics, including leadership in at least two national bioethics associations and participation in the Wanglie case, which clarified Minnesota law regarding demands by families for medical care that physicians believe not to be beneficial.
I found it even more shocking that there was no indication in Psychiatric News that APA has done anything to support Dr. Miles in his complaint against the state medical board. Surely Dr. Miles is right that it is gross discrimination for the board "to presume a physician is impaired based on certain psychiatric diagnoses until the physician proves otherwise." It is the responsibility of APA, which is committed to overcoming stigmatization of psychiatric patients, to counter such discrimination wherever it occurs. Furthermore, as Dr. Miles points out, the board’s presumption that a history of mental illness implies impairment "is a potent deterrent to candor and is counter-therapeutic"; therefore, it works against the best interests of the very patients whom the board is trying to protect.
As established by the federal Office of Civil Rights, it is appropriate for state licensing boards to ask physicians who are applying to renew their licenses, "Do you have a medical condition which in any way impairs or limits your ability to practice medicine or to function as a physician?" It is counterproductive, discriminatory, and probably illegal to require disclosure of psychiatric diagnoses and treatment, in the absence of such impairment.
This is an issue of great importance to psychiatrists, to physicians in other branches of medicine, and to medical and psychiatric patients. I have written to the medical director of APA, urging him to try to persuade the Minnesota Board of Medical Practice to mend its ways. I encourage other members to do likewise.
Cavin P. Leeman, M.D.
New York, N.Y.