When a new doctor-patient comes to my office, my eyes are already peeled to look for substance abuse

"Is this Dr. Freedman?” The voice was that of a middle-aged woman from Brooklyn with a nervous edge.

“I certainly hope so,” I answered as I skipped through the Old City, having finished my morning chavrusa, making my way to the office for afternoon appointments.  “What can I do for you today?”

“Which Dr. Freedman?”

“The one who answered the phone number that you dialed,” I responded, trying to alleviate her anxiety with a bit of humor.

“Oh. Well, you see, there are so many of you and I need to make sure you’re the right one.”

“It could very well be me, if you’re looking for a psychiatrist.”

“Okay, fine,” she seemed relieved. “So, are you the Dr. Freedman who has experience in treating other doctors? Because apparently you were recommended by your colleague Dr. Berg to treat his colleague Dr. Berger.”

I knew Dr. Berg well — a cardiologist who worked in a multi-specialty practice in Ramat Beit Shemesh. I had no idea who Dr. Berger was, though.

“I’ll treat anyone except an arsonist or an ax-murderer,” I answered honestly. “And yes, I have been zocheh to have treated other physician patients in my career,” I said as I tried to resist the urge to make another bad joke.

“So, you’ll be able to work with Dr. Berger? You think you have the skills to help him?”

I wasn’t sure if this was his secretary, his wife, or both, but as always in these cases, discretion was called for as we booked an appointment for the following week.

Dr. Berger was a respectable-looking fellow in a blue button-down shirt and black slacks.

“So, you’re Berger the friend of Berg who’s looking for Freedman the psychiatrist?”

“Correct.” He laughed nervously as he sat down and anxiously dry-washed his hands. “But I hear you’re not experienced in treating ax-murders and arsonists?”

“False, actually,” I said flatly. “I used to evaluate all sorts of tough characters when I moonlighted as a forensic psychiatrist for the courts back in Boston. You’d be surprised what kind of characters end up needing a good frum psychiatrist.”

“You’ve actually treated a murderer? An arsonist?” Dr. Berger asked incredulously.

“Well, I once evaluated a serial killer, I’d consulted on three cases of arson, and one guy who was guilty of both. No joke.”

“Okay, I’m impressed. Anyone you refuse to treat?”

“Repeat perpetrators and child-abusers,” I replied. “Gotta draw the line somewhere.”

Dr. Berger nodded a bit apprehensively as he asked, “And doctors? You’ve treated doctors before?”

“Yep. Don’t worry, you’re not alone.”

And it was true. I’d had experience treating professionals from all walks of life, including my fellow physicians. These were the guys on the front lines who needed help the most sometimes.

“Well, um, where do I start? I mean, I just want to make sure this is confidential before we start, I mean, I can’t have anyone finding out I’m here because—”

I cut him off because there was a very clear answer he needed to hear if he was going to be able to work with me. “Unless you’re an ax-wielding pyromaniac who hurts kids — which I assume you aren’t — then I’m sure we’ll be able to get to the bottom of this and help you get back to the point where your wife and your good friend Dr. Berg won’t be worried that your problem is out of control.”

“What? Who said anything about a problem?!” He cringed defensively. “You think I have some kind of addiction?!”

The truth was that I didn’t, but I’d also seen enough physician-patients to know that doctors experience stress just like everyone else and perhaps even more so. Managed-care, litigious systems, caring for dying patients, expectations to pay full tuition for school despite medical school bills… the stress levels were often through the ceiling. Every mental health professional is well aware that doctors turn to pills and alcohol just like everyone else, and research suggests that physicians may develop addictions at a greater rate than their peers in other professions.

So, when a new doctor-patient comes to my office, my eyes are already peeled to look for substance abuse.

And then there’s the pattern I’d seen so often: anxious, nondescript professional males in their forties who are nervous about discussing the reason they’re sitting here are more likely than not to be experiencing some sort of problematic substance use or addiction.

And apparently, I was right.

Dr. Berger was quick to respond defensively to my hint. “So what if they think I have a drinking problem? They aren’t professionals.”

“This is true, Dr. Berger, but they’re obviously worried about you. Still, I’m really glad to hear that you don’t have a drinking problem.”

Silence.

Then, “So what are we gonna do about the fact that they think I have a drinking problem, Dr. Freedman?” he asked. “How can you get them off my back?”

“Hmm… well, maybe you tell me how all this started. Let’s begin with the facts….”

“What facts? Like the fact that my wife and our mutual colleague, my supposed best friend, conspired against me and told you a bunch of lashon hara?”

The emes was I hadn’t spoken to either Dr. Berg or to Mrs. Berger. They had both respected his privacy as often happens when health-care providers — wary of professional repercussions — come to seek treatment.

“I never spoke with either of them,” I stated.

“Well anyway, they’re concerned about me having a drinking problem.”

“Why is that, Dr. Berger?”

“I think it’s just overkill, I mean, I’m completely fine.”

“Then why are they concerned that you have a drinking problem?”

“Because my wife is an anxious lady and our mutual colleague is a recovering alcoholic, which means he thinks everyone has a drinking problem,” he offered snidely. “AA guys in recovery always think everyone’s an addict like them.”

Now who’s speaking lashon hara, I thought to myself, although I didn’t want to bring up the obvious breach of anonymity and risk further alienating Dr. Berger.

“They think everyone has a drinking problem?”

“Pretty much.”

“Who else do they think has a drinking problem, Dr. Berger?” I asked sincerely.

“Well, I mean, you know what I mean,” he said, realizing he’d fallen into a trap of his own making. “Goodness, is this an inquisition?” He laughed nervously.

It wasn’t an inquisition because there wasn’t going to be any need for torturing or false confessions. Dr. Berger had two people who knew him well and were worried about his drinking.

“You’re trying to get me to say that I must be doing something wrong if he thinks I have a drinking problem?  That’s what you’re fishing for?” he asked with marked frustration.

Dr. Berger took a deep breath and answered his own question. “Look, I’m having a tough time trying to make it as a family doctor here, and it’s basically been catastrophic for my family to make aliyah from a big house in the Five Towns to a tiny apartment and everything else that goes with it, Dr. Freedman.”

“I can empathize. Sounds rough. And that makes you an alcoholic?”

“No. Not at all. It just means I need a drink to relax sometimes.”

to be continued...

Identifying details have been changed to protect the privacy of patients, their families, and all other parties.

Jacob L. Freedman is a psychiatrist and business consultant based in Israel. When he’s not busy with his patients, Dr. Freedman, whose new book Off the Couch has just been released in collaboration with Menucha Publishers, can be found learning Torah in the Old City or hiking the hills around Jerusalem. Dr. Freedman can be reached most easily through his website www.drjacoblfreedman.com.

(Originally featured in Mishpacha, Issue 873)