A fter a few years of receiving one or two of these phone calls a week often from people we know my wife was getting used to them.

“Hi. Listen your husband is a psychiatrist right?”

“Yep.”

“Like a doctor who sees patients for mental illness right?”

“Yep.”

“Kind of like a psychologist or a neurologist or maybe something in between right?”

“Yep.”

“So he can help my husband?”

Now my wife knows that treating a friend is a tricky business and usually not a good idea. “I’m sure he’ll try his best ” she answers “but it would probably be easiest if your husband called to speak with Yaakov himself. Remember they’re friends. Yaakov is always happy to help his friends.”

This was my wife’s thoughtful way of planting the seed that I can’t really be a psychiatrist for my friends. Not that I don’t want to help them chas v’shalom. But providing treatment for one’s friend isn’t as simple as some people might think — after all I already know him and probably am already aware of his issues so doesn’t that make things easier? In fact it’s actually pretty complicated — and potentially an ethics violation as a conflict of interest. Doctors are supposed to be on strictly professional terms not social terms with their patients.

Sure I’m always happy to participate in the simchah of a patient. In fact one of the most memorable weddings I’d ever attended was that of one of my patients who’d finally conquered his illness and was ready to tie the knot — I can’t begin to describe the joy of seeing him dance with his father at the chasunah. But to provide psychiatric treatment for someone who was already a buddy of mine... that’s just not a great idea.

And then there’s that gray area where ethics and friendship meet — and sometimes clash. I’ll never forget the time a good friend asked me to write him a prescription for Concerta (a stimulant medication to boost concentration for people with ADHD) so that he could “study hard in order to pass the bar exam.”

“That’s not such a good idea Izzy ” I told him.

“But it’s easy for you to do it. You already know me so you don’t even need to see me for a visit.”

“That’s the point Izzy. I already know you. You’re my good friend. Plus you don’t have ADHD or any psychiatric problems. Baruch Hashem you’re healthy and sane as can be. All you need to do is study hard to pass this test.”

Izzy sure was persistent. “I guess but I could study harder if I took some Concerta don’t you think?”

“I don’t know Izzy because you’re not my patient and I’ve never been your doctor. All I know is that you’re my friend and your wife is friends with my wife. You guys are coming for Shabbos dinner next week! Let’s also not forget that you’re going to be a lawyer and will have to answer questions about whether or not you’ve ever been diagnosed with a psychiatric illness or treated by a psychiatrist. That’s not going to be an easy question for you to answer if you get a prescription from me.” Not to mention the fact that this medication was a federally-regulated prescription and that I’d be red-flagged should anything go awry. I specifically remember hearing during my medical training of the case of a physician who had lost her medical license over a very similar affair.

But beyond the fact that there are ethical and legal dilemmas associated with providing psychiatric care to friends there are also a bunch of practical reasons why it doesn’t work. Consider the fact that many of my patients have personal struggles and concerns that are difficult or embarrassing to talk about. Would my friend Effy feel comfortable telling me that he’s out of work again and had to sell his SUV to pay the mortgage last month? Didn’t his wife Suri just tell my own wife that they had decided they didn’t need two cars anymore because he was taking the trolley to his new consulting gig? And what would happen if Shimon had relapsed on pills again and needed detoxification or another rehab stay... Would he still be willing to come forth with this information if he had to see me at our sons’ little league game the following day? What about issues related to marriage infidelity and internet addiction... would Yossi be too ashamed to discuss these important topics if our daughters were in the same preschool? And let’s not forget what might happen if my next door neighbor required involuntary hospitalization — how would that be possible to facilitate without sacrificing our relationship?

So it’s not that I don’t want to help it’s just that sometimes I’m better off being a friend than a psychiatrist. I’m happy to assist by answering questions and making referrals to top-notch colleagues. This is easy for me to do and it’s my pleasure to use my professional knowledge to help ensure that my friends receive the highest quality of care. I’m also there as a shoulder to cry on someone to talk to or even to provide a blanket and a couch for a friend who was kicked out of his home in the middle of the night. But to provide psychiatric treatment or to write prescriptions? That’s something better saved for someone else.

I remember once when I was a kid and went with my dad to a Boston Red Sox game when they were hosting the New York Yankees. Emotions were high and it was an exciting game so I was standing up on my seat to root for my favorite players. The guy behind me had a bit too much to drink and yelled at me “Hey kid! You make a better door than window! Get out of my way ‘cuz I can’t see!” My dad wisely helped me down and told me to cheer from my seat instead. The point is we all serve different roles for different people. In addition to being a better door than window for that intoxicated guy I’ve found that I make a better friend than psychiatrist for my buddies. (Originally featured in Mishpacha Issue 665)

Jacob L. Freedman is a psychiatrist and business consultant based in Jerusalem. He serves as the medical director of services for English-speakers at Bayit Cham a national leader providing mental health treatment and outreach within the religious community