American College of Physicians: Internal Medicine — Doctors for Adults ®

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What about 'country'?

The December issue of ACP Observer described a 39-year-old active-duty army intelligence officer with post-retirement plans to work for the Department of State who is severely depressed over the death of his gay lover (Documenting sensitive information poses dilemma for physicians). The discussion explored the physician's obligation to protect the patient's privacy by making sure the armed forces did not learn of the patient's psychiatric condition, but not once did the article mention the notion of "country."

I realize that patriotism is passé, but the United States has good reasons for trying to ascertain the reliability of those in sensitive positions. The authors are probably correct that the officer's career would be put on hold if details of his health were known. That's because many of these sensitive positions are incompatible with significant mental illness, certain medications and some health problems. Would you be comfortable with this officer/patient commanding a nuclear missile silo?

As a colonel, I cared for CIA operatives working in Eastern Europe. If the Soviets had subverted individuals with access to CIA and military intelligence because of a perceived weakness such as mental illness—individuals like the one described in the story—those operatives would likely suffer a cruel death by torture. One defector can cost hundreds of lives.

Military physicians frequently encounter personnel in highly sensitive jobs, individuals who use or develop secret technology and others who must maintain superb judgment for critical decisions. Obviously, a mentally ill intelligence officer will seek out an innocently naive civilian physician for care.

David E. Langdon, FACP
Arlington, Texas

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