Dr. Boyd has made a seminal contribution with this publication. I have studied the area of PHPs and medical Boards for over ten years. While I have never been personally referred to a PHP or medical board I am frequently called by physicians and attorneys to ask my views on a particular case of a physician who finds himself involved with a PHP or medical Board.

I am Professor Emeritus in the Department of Psychiatry at Duke University and was Vice Chairman in charge of the educational programs within the Department. In addition to being a Board certified psychiatrist I am certified by the American Psychoanalytic Association in psychoanalysis and served as a Teaching Psychoanalyst for many years at the Duke-UNC Psychoanalytic Institute.

I have noted the following facts and have the following concerns about the PHP and the medical board in my home state. The PHP in my home state appears to make diagnoses that are not supported by the required diagnostic criteria for that diagnosis. When confronted by me with questions about how this is possible, the personnel at the PHP refused to answer. One doctor, Dr. A., was referred to the PHP on the complaint of an anonymous person who alleged that Dr. A smelled of alcohol. Dr. A requested or demanded a blood alcohol level or Breathalyzer test to prove his innocence. This was not done, but Dr. A was referred to a diagnostic/treatment facility by the PHP. Dr. A had extensive psychological testing that revealed no anxiety or depression, and the medical director/substance abuse specialist stated that he did not have even alcohol abuse, but he was told that he had to be hospitalized for inpatient treatment. He refused hospitalization.

I attempted to take this case to the medical board. Interestingly, the Medical Director of the medical board, the President of the medical board, and the entire medical board refused to meet with me to discuss this case and other cases. These facts in and of themselves should raise concern in the mind of any physician. I attempted to put my concerns in writing to these same individuals, and to a person each of them refused to even acknowledge receipt of the questions. An attorney wrote me and directed me to direct all my questions to the medical board, the Medical Director of the board, or to members of the medical board to him only. No one ever answered these rather burning questions.

As a psychoanalyst whose practice was almost exclusively physician patients, I am alarmed that all of the physicians sent to the PHP seem to end up in a “one size fits all” treatment program. One physician patient complained to me that he was in “treatment” for ninety days, and that treatment consisted of going thru the standard thirty-day treatment format three times. The physician patient found such to be worthless, demeaning, and a total waste of time. As a psychoanalyst, I am appalled at this alleged treatment. That patient should have an in-depth diagnostic evaluation and then a treatment focused upon that physician patient’s intrapsychic conflicts. I directed questions to the medical board as to what evidence-based medical literature exists to support such a “treatment” and again received no meaningful response from the medical board.

The issues noted in Dr. Boyd’s paper, the comments of persons who have commented on the paper, and the questions I have raised here should be concerning—no, alarming—to every physician in this country.

Jesse O. Cavenar, Jr., M.D.