Dr. Baldassano, the Bold

Dr. Claudia Baldassano’s reputation precedes her. A self-proclaimed maverick who thrives in strict academic and religious institutions, a churchgoer and rule-breaker, a serious scholar with an infectious laugh, a bubbly optimist who treats refractory depression … who is she? For years, I heard manic and psychotic patients sing her praises and wondered.

“She’s the best,” her patients proclaimed amidst unbroken strings of pressured speech detailing their extramarital affairs, $100,000 spending sprees, and elaborate paranoid conspiracy theories.

“She saved my life,” was the common conclusion from patients wealthy and homeless, young and old. All claimed to have her cell phone number and to be in close contact.  I was suspicious. She manages 1,000 patients. How was this possible?  

I joined her bipolar clinic to find out. On my first day, I evaluated a woman with borderline personality disorder and bipolar disorder. A demanding, chronically ill, difficult to treat patient who had failed countless medication trials, she wanted “a new treatment” to start today. Hesitantly, we agreed, but it seemed futile.

“Will this cure me?” the patient asked solemnly, eyes wide and hopeful. It was a strangely naïve question, but she seemed sincere.

Dr. Baldassano burst out laughing.  “Cure you? Nothing will cure you!”

I gasped. The room went silent. I had never before heard a doctor say this to a patient without a terminal medical diagnosis. The patient looked startled. I braced myself. Would she yell? Cry? Storm out, never to be heard from again?

“You’ll never be cured, but you will get better and we’ll never give up on you,” Dr. Baldassano continued.

The patient brightened. She accepted this. She left clinic calmly and returned monthly, never missing an appointment, and she really did get better. She thanked us. She trusted us. I was shocked.

“I say what I want,” Dr. Baldassano told me later, “but I treat people well. Patients pick up on it when you really care about them and I truly do. That’s why I can say what I want. We don’t give up here, we don’t roll our eyes, we jump right in and work hard until they get better.”  

Dr. Baldassano is the most traditional rebel I’ve ever met. Church every Sunday has been a staple throughout her life since childhood. She was one of five children and has three of her own. She cooks big family feasts and serves on school committees. She described herself as “a goody two shoes” growing up. She was popular, got straight As, never got in trouble, and became her all-girls Catholic high school’s valedictorian. She pursued medical school without much thought. She was good at science and it seemed like the logical choice.

Hires_Baldassano“I’m a dichotomy,” Dr. Baldassano admitted. “I’m quietly rebellious and yet, I force my kids to go to church every Sunday morning.”

It is Dr. Baldassano’s deep belief and comfort in systems, rules, and structure that allow her to break them. She does so with a sense of purpose and a belief that rules governing medical care, like religious laws, are guidelines to help people do the right thing.

“I’m a maverick. I buck psychiatry in a lot of ways,” she explained. “I don’t need things black and white. I’m not anxious and I’m comfortable not knowing everything.”

For Dr. Baldassano, patients come first, period. Nothing else matters. When rules cease to serve patient care, she stops heeding them.

“I prioritize recovery over restrictions. If I don’t see the logic in it, I won’t do it,” Dr. Baldassano said. “I can’t treat patients’ family members…? why not? I treat eight members of one extended family! And yes, I really gave all of my patients my cell phone number the minute I got one.”

When I first announced I was looking to profile someone for the Unspeakables & Ineffables issue, Dr. Baldassano was the quick pick of many faculty and residents. Interestingly, though, the more I poked and prodded, the more I reaffirmed her deep respect and appreciation for rules and systems, the opposite of what I expected.

Dr. Baldassano does want to change psychiatry, but not so much by breaking rules as by creating new, better rules. She wants psychiatry to be structured, scientific, and evidence-based.  If anything, she wants to make psychiatry more rigid. “I want us to have respect,” she said.

Just before this article was set to print, The New York Times called Dr. Baldassano and me. Our letter to the ethicist on discriminatory, manipulative practices used by insurance companies was accepted for publication.

“Are you sure you want yourselves and your institution named?” the editor asked, “Writers usually wish to remain anonymous.”

“We want our names used!” Dr. Baldassano said. “We’re proud of what we do and say.”

I was reminded of why Dr. Baldassano was the right choice for this article. She is rebellious because she is unafraid to speak about what’s wrong with the medical system and psychiatric practice locally and nationally.

As Behdad Bozorgnia, a resident in her clinic, put it, “Dr. Baldassano cares about patients and doesn’t care about bureaucracy. In an increasingly administration-driven healthcare system, that’s pure rock n’ roll.”  

She is one of the few physicians I ever trained with who never, under any circumstances, prioritizes protecting herself legally or guarding her reputation over equity, justice, and all of the tenets of the Hippocratic Oath that so often get lost in the spider web of bureaucratic rules and guidelines designed to protect institutions to the detriment of patients. That’s a notion so rebellious, it borders ineffability.

Lisa Jacobs, MD, MBA, is a third year psychiatry resident at Penn and the founding editor of this magazine.

Claudia Baldassano, MD, is an Assistant Professor of Clinical Psychiatry and the Director of the Bipolar Disorders Clinic at Penn.  

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