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What I find most disturbing about this letter is the sentence “Just don't tell me about it.” How can we impose a “Don't Ask, Don't Tell” policy on our patients? In psychiatry, open communication is essential to our work. It is crucial to be able to acknowledge and discuss anything that transpires during the course of a treatment. In the service of increased trust, understanding, and awareness, we encourage patients to be as open and honest as possible.
This letter creates an event and then directs the patient not to discuss it with the psychiatrist. I gather the idea here was to maintain some kind of ethical “correctness,” that is, to protect the patient from possible coercion related to the imbalance of power in the doctor-patient relationship. However, even if “technically” correct, this letter is not true to the spirit of the psychotherapeutic endeavor and demonstrates a striking lack of judgment. What could be more counter-therapeutic than setting up a no-win situation for the patient who receives contradictory directives and is left no avenue of resolution? What kind of message is conveyed by this behavior?
Certainly, the lack of funding for both clinical and research goals is a serious and significant problem for our field and certainly psychiatrists face unique difficulties in fundraising. Nonetheless, this approach is not only ill-conceived but also probably not very effective.