December 18, 1998

I believe there is every reason to hope that the verdict against Myron Liptzin, M.D. (Psychiatric News, November 6), will be reversed on appeal. There is, however, one important lesson that can be heeded at this time.

Aside from the fact pointed out by Renee Binder, M.D., that psychiatrists should not read too much into the verdict because it does not set legal precedent, it should be noted that Dr. Liptzin commented that if he had to testify again, he would be "more humble" than he was during the trial.

I strongly recommend that colleagues, before testifying in court for the first time, consult with a psychiatrist certified in the subspecialty of forensic psychiatry. To paraphrase Georges Clemenceau: Psychiatric testimony is much too serious a matter to be entrusted to the legal profession.

Abraham L. Halpern, M.D.
Mamaroneck, N.Y.

The case of Myron Liptzin, M.D., illustrates a tragic conclusion that every young psychiatrist may come to believe: One had better be indemnified if one fails to instantly terminate (or "dump") a patient who has the remotest chance of committing a deviant act toward others, particularly if he or she has shared this possibility with you, even in the most abstract therapeutic interchange as a fantasy.

Tragically, many psychiatrists think they are doing society a favor by second-guessing the decisions made under duress by psychiatrists in the "line of fire."

What damages the morale of psychiatrists in private practice the most is what we keep doing to each other rather than the shenanigans that lawyers and politicians are perpetrating. Mental health HMO and PPO "gatekeepers" are most often other psychiatrists, as are most expert witnesses for plaintiffs and the academicians who constantly write "standard-of-cure papers," oftentimes excluding all but their concept of treatment regimens as outmoded.

I often wonder whether the cutthroat competition of premedical and medical training is properly disposed of in a good psychiatry residency or simply reemerges as fuel for second-guessing in the competitive "expertness" of Monday-morning quarterbacking.

Evan M. Torch, M.D.
Atlanta, Ga.