Psycho-Babble Medication Thread 3230

Shown: posts 4 to 28 of 46. Go back in thread:

 

Re: I'm here, but of no help

Posted by Victoria on February 26, 1999, at 18:17:16

In reply to Re: I'm here, but of no help, posted by Matt on February 25, 1999, at 22:17:20

I'm barely computer literate, but I have found that when the connection gets stuck on "connecting", it sometimes works just to quit that attempt and start over. Often, it connects quickly the second time. Also, time of day seems to matter. I have more trouble getting through during weekdays, more luck evenings and weekends.


> > I can't read any of the posts. Ever since the site was changed to the new format with the window-in-window, I can't get in and read the posts except for maybe one or two every now and then. I get a message of "connecting," but it never completes the connection. I will keep trying. Suggestions from the computer literate readers?
>
> I had this problem too, with the old address
>
> http://www.dr-bob.org/babble/
>
> Have you tried the other two, too?
>
> http://www.dr-bob.org/babble
> http://www.dr-bob.org/babble/babble.html
>
> Matt

 

Microsoft problems?

Posted by Dr. Bob on March 2, 1999, at 1:37:29

In reply to Re: I'm here, but of no help, posted by DL on February 25, 1999, at 19:06:12

> > I can't read any of the posts. Ever since the site was changed to the new format with the window-in-window, I can't get in and read the posts except for maybe one or two every now and then. I get a message of "connecting," but it never completes the connection...
>
> I had the same problem. I would click on a post, and except for usually the first one, I wouldn't get anywhere. Then I found that it really had connected but I had to go to the little "minimized" rectangle ("window") at the bottom of the screen in the strip called the "status bar" on my computer (Windows 95, Microsoft Internet Explorer)----and click on it.

Oops, sorry, I thought I had everything fixed. Does the site treat everyone with Windows this way?

Most of the other computers at work use Windows, I'll try to remember to test out the site on one of them tomorrow. But most of us use Netscape. If you're having problems with IE, you might want to take a look at the competition:

http://home.netscape.com/comprod/mirror/index.html

Bob

 

Re: Update browser?

Posted by Jack on March 2, 1999, at 13:03:43

In reply to Microsoft problems?, posted by Dr. Bob on March 2, 1999, at 1:37:29

Maybe download a newer version of your browser.

 

Re: Update browser

Posted by Toby on March 4, 1999, at 7:58:01

In reply to Re: Update browser?, posted by Jack on March 2, 1999, at 13:03:43

I got my center's computer expert to come in and update my browser and some other things to make it a little faster, so now I can catch up. I've missed hearing how everybody's doing.

To Dottie: Way to go!! I hope the session goes well.

 

Re: EMDRvs.INTENSE THERAPY

Posted by Susie on March 4, 1999, at 11:50:20

In reply to Re: Update browser, posted by Toby on March 4, 1999, at 7:58:01

Is it possible that 1 intensive week of therapy could be as effective as 6 months of weekly sessions or have you seen better results from EMDR? The counseling sessions would be 4-5 hours per day with free time/homework time. Is it wise to use Xanax to allow freedom in communication and control of anxiety during sessions? The Xanax has been prescribed for sleep but makes counseling less frightening and more manageable. Yes, I will check with my doctor but what do you think? Welcome back Toby. You were missed.

 

Hello Toby, glad you're back!

Posted by DL on March 4, 1999, at 21:15:43

In reply to Re: Update browser, posted by Toby on March 4, 1999, at 7:58:01

> I got my center's computer expert to come in and update my browser and some other things to make it a little faster, so now I can catch up. I've missed hearing how everybody's doing.

It's great to have you back on board!!!....Missed your caring, respectful, knowledgeable responses. Hope the computer update works well.
>
> To Dottie: Way to go!! I hope the session goes well.

Took a while to connect with her. She initially said she had no openings. But after talking with her on the phone for a while she said she would be able to see me in April (8th). She teaches at UNH part of the time in the psych dept and sees clients on T and Th at her home office. She worked with a group practice for a number of years before this, and also is mentoring another therapist part time. I liked her a lot on the phone. She also gave me her e-mail at UNH and I did message her once to see if she wanted me to get my records for her. Also sent out some questions for me to answer and bring with me. She e-mailed back with the names of 2 psychiatrists she knows who work well with psychologists and that she things highly of (since I had asked). I may switch to one of them if I can.(another small hurdle to get over). Mental Health Center would not give me my records. Only would send them to her....I never thought to see them before, but now that makes me wonder what's in them?

Thank you so much for your help.--That on-going support has pulled me through some tough times.

Starting to slowly gain self-confidence in my work. Getting some nice feedback. Weight problem still won't go away--disappointing. I did try one package of Zantac. VERY expensive especially at the dosage you listed. Didn't take it long enough to tell if it would help for weight. I did notice that I was more comfortable lying down. I have used 2 pillows since perimenopause --otherwise acid seeps back up.

Hope all is well with you.
Dotty

 

Re: EMDRvs.INTENSE THERAPY

Posted by Jo Ann Kurek, LISW on March 9, 1999, at 23:48:33

In reply to Re: EMDRvs.INTENSE THERAPY, posted by Susie on March 4, 1999, at 11:50:20

I know I'm new here but would like to venture some help. I use EMDR quite successfuly with some clients. It depends on the issues their addressing and their desire to overcome the problem. Usually EMDR gets to the root of the problem,usually faster than other interventions. It is especially good with trauma, past abuse, etc, depression and anxiety but has many other uses. Of course, you want to check with your doc.
Be glad to give more details on EMDR if you Email me your questions.

 

Re: EMDR

Posted by Betsy on March 11, 1999, at 16:38:17

In reply to Re: EMDRvs.INTENSE THERAPY, posted by Jo Ann Kurek, LISW on March 9, 1999, at 23:48:33

> I know I'm new here but would like to venture some help. I use EMDR quite successfuly with some clients. It depends on the issues their addressing and their desire to overcome the problem. Usually EMDR gets to the root of the problem,usually faster than other interventions. It is especially good with trauma, past abuse, etc, depression and anxiety but has many other uses. Of course, you want to check with your doc.
> Be glad to give more details on EMDR if you Email me your questions.

I distrust any therapist who claims that his or her therapy gets to the root of the problem." In most cases, nobody can say with any certainty what "the root of the problem" is. This is just a cliche' way of trying to set a particular therapy apart from any other therapy. Psychoanalysts say their therapy gets to the root of the problem while cognitive-behavior therapy just scratches the surface. Anti-meds people say that therapy gets to the root of the problem and meds just cover it up. etc.

As an aside --- haven't ,most or all of the well-designed studies of EMDR tended to show that the eye movements are worthless?

 

Re: EMDR

Posted by Toby on March 12, 1999, at 12:20:38

In reply to Re: EMDR, posted by Betsy on March 11, 1999, at 16:38:17

If anybody wants additional information about the mechanics of EMDR, check their website at www.emdr.com; it explains what happens, how it is suspected to work and has a listing of all the research that has been done on it. There has actually been more studies done on EMDR than on any other treatment for PTSD. Some of the earlier studies done by people not directly involved with EMDR did show that it was not effective, but those studies were not well-designed and did not even use the correct protocol for doing the procedure. More recent studies done with the correct procedure and control groups do show that it is more effective than exposure therapy, cognitive-behavior therapy, interpersonal therapy or supportive therapy. I believe they are doing some comparison studies of EMDR with hypnosis as well since some clinicians have the mistaken idea that EMDR is just hypnosis and suggestion.

JoAnn asked about intensive therapy for 4-5 days vs EMDR. Is this program like a partial hospital program? These programs are very helpful and do give the opportunity for insight and growth and since it is very intensive, much can be accomplished in a short while. I can't really compare it to EMDR without knowing what it is that is being addressed (depression, anxiety, trauma, etc). I don't recommend that Xanax or any other medication be taken specifically to deal with the anxiety that is provoked during therapy since it is the anxiety that really propels the changes that occur (emotionally, chemically, behaviorally). Of course, that is still an individual question and is best addressed between the patient and their doctor.

To Dottie: In general, psychiatric records are different from regular medical records and are not released directly to the patient. The reason being that what therapists say about patients can be hurtful to the person. Therapists don't go around insulting patients (I hope) but the language that is used in psychiatry is not the same as in everyday language and can be misinterpreted by patients who aren't familiar with the specific psychiatric meanings. Also, therapists document lots of detail about how patients look, act, talk, and lots of things about underlying meanings etc that helps the therapist try to dig out what is causing the patient problems. However the patient is usually not aware of all the underlying meanings and is usually unaware of how they look and act and talk and may find all of this detail distressing and feel that the therapist has a low opinion of them, when really it's just the way we document what we see and is meant to be beneficial in the long run. For these reasons, psychiatric records are generally not given to the patient (although some doctors and therapists will sit down with the patient and let them read the chart so they can be available to answer any questions the patient has).

 

Medical Records

Posted by DL on March 12, 1999, at 23:50:50

In reply to Re: EMDR, posted by Toby on March 12, 1999, at 12:20:38


> To Dottie: In general, psychiatric records are different from regular medical records and are not released directly to the patient.

I guess I understand. I know I write things in the infants charts sometimes that I would want to explain to caregivers. Perhaps the therapist will give me an overview of what is in the records so I will know what kind of impression she has made of me (since she will have them before even meeting me). Waiting for April 8. Will go in during my work day--schedule appts around it. Really need someone to give me a fresh perspective on me. Doing OK at work but not motivated to do things with others on off time--just come to my safe place to "be".

Question: do you have any sources of information on ID'ing the autism spectrum in infants (8 mos)? I evaled a baby today with no eye contact and no real interst in people, things, environment. Looks for a long time at light sources. does not laught, smile or engage even with mom. Referred for gross motor delay due to prematurity. I do not have much experience with Autism but this seems to be somewhere in that area.
Dotty

 

Medical Records

Posted by Dr. Bob on March 13, 1999, at 18:13:27

In reply to Re: EMDR, posted by Toby on March 12, 1999, at 12:20:38

> In general, psychiatric records are different from regular medical records and are not released directly to the patient. The reason being that what therapists say about patients can be hurtful to the person... the language that is used in psychiatry is not the same as in everyday language and can be misinterpreted by patients... (although some doctors and therapists will sit down with the patient and let them read the chart so they can be available to answer any questions the patient has).

It's true that in general psychiatric records aren't released to patients. However, patients may have the legal right to have access to them. It probably depends on state law. When patients ask to see their charts, I do think it's a good idea for the psychiatrists to be there.

IMO, psychiatrists should be careful what kind of language they use in charts. Not only for this reason, but also because charts are legal documents.

Bob

 

Re: Medical Records

Posted by Elaine on March 14, 1999, at 23:26:58

In reply to Medical Records, posted by Dr. Bob on March 13, 1999, at 18:13:27

While I, as a patient, may want to see a therapist's or psychiatrist's records, given the subject matter - emotions, thinking patterns, etc. - it would probably not be in my best interest to pursue that. However, I believe that any good mental health practitioner would be willing to discuss his or her impressions, diagnosis, thoughts on treatment, etc. in a way that would be understood and acceptable to each individual patient. I have been fortunate in that regard. I would question any practitioner who refuses to discuss at least the generalities of their findings. That can do nothing but leave a patient to imagine or assume the worst, or distrust the secretive practitioner.

 

Muscle Tension-Jaw

Posted by DL on March 16, 1999, at 20:33:19

In reply to Medical Records, posted by DL on March 12, 1999, at 23:50:50

Remeron has reduced anxiety and "mental tension", but I am noticing more and more that it does not affect physical-muscular tension from stress or whatever. Back last Fall when I was still taking the tiny dose of klonopin it was less noticable to me. Over the last few months the tension in my jaw that I talked about a few months ago has gotten worse. One side of my jaw at this point seems to have become sort of "disjointed". I have to make sure I don't open my mouth too far. Very painful and it seems to come undone at the joint and not go back where it belongs. Is this from tension/stress? I have always had some trouble with my jaw but nothing like this. Any ideas?

 

Re: Medical Records

Posted by Elizabeth on March 17, 1999, at 22:19:26

In reply to Medical Records, posted by Dr. Bob on March 13, 1999, at 18:13:27

> It's true that in general psychiatric records aren't released to patients. However, patients may have the legal right to have access to them. It probably depends on state law. When patients ask to see their charts, I do think it's a good idea for the psychiatrists to be there.
>
> IMO, psychiatrists should be careful what kind of language they use in charts. Not only for this reason, but also because charts are legal documents.

I'm rather surprised by the idea that I might not have a right to my own medical records. What is the rationale (or rationalization?) for this? I mean, what is the potential harm that could be done?

-elizabeth

 

Re: Medical Records

Posted by Susie on March 19, 1999, at 9:05:23

In reply to Re: EMDR, posted by Toby on March 12, 1999, at 12:20:38

Elizabeth, did you read the previous post in this thread (EMDR on 3/12/99 by Toby)? The answer he gave re. medical records was very helpful to me and made perfect sense.

 

Re: Medical Records

Posted by Elizabeth on March 20, 1999, at 11:41:29

In reply to Re: Medical Records, posted by Susie on March 19, 1999, at 9:05:23

> Elizabeth, did you read the previous post in this thread (EMDR on 3/12/99 by Toby)? The answer he gave re. medical records was very helpful to me and made perfect sense.

Yes, I understand the reasons that are usually given for this sort of policy, but they do not seem to me like good, ethical reasons; they seem like paternalistic ones.

 

Re: Muscle Tension-Jaw

Posted by PL on March 21, 1999, at 21:07:19

In reply to Muscle Tension-Jaw, posted by DL on March 16, 1999, at 20:33:19

I started on remeron to control the TMJ side effect of effexor in me. Please see my posting titled "Remeron Side Effects" to see what happened next.

 

Re: Medical Records

Posted by Toby on March 23, 1999, at 15:39:44

In reply to Re: Medical Records, posted by Elizabeth on March 20, 1999, at 11:41:29

Paternalism and ethics are not mutually exclusive concepts. Paternalism is defined as doing something for someone's benefit without that person's consent. This is the concept that governs guardianship, parenting, and involuntary commitments. Ethics involves a set of principles guiding a person in deciding what is right or wrong. While everything a physician does should be governed by ethics, not every decision is paternalistic; hence the informed consent idea. There have been examples of unethical paternalism such as the involuntary sterilization of mentally retarded persons back in the 50's and currently there is the great debate about euthanasia and Dr. Kervorkian's actions. With regard to allowing a patient free and unsupervised access to their psychiatric record, there is obviously a paternalistic aspect since the therapist is presumed to have knowledge that the patient may be incapable of understanding or, in the therapist's judgement, may be better off not knowing, but as Dr. Bob said, ethics would dictate that if the record is opened to the patient, the therapist should be present to discuss those issues with the patient. The previous statement may offend many who read it here, since most folks who can operate the internet are fairly well educated and believe that they know just as much as any therapist or psychiatrist when it comes to their own mental illness. However, if that were true, there would be no need for anyone here to be seeing a therapist or psychiatrist, much less dialoging here about various forms of treatment experiences. On the other hand, many folks understand the need for experts, but want to be privy to all the juicy details that the therapist may write down. IMHO that is tantamount to gossip about yourself; it's like wanting to read true-crime best sellers where the experts' reports are laid out for all to see about how some killer became that way; it's like wanting to see all the fluids and fat from your liposuction (i.e., you don't need to see it to know that it's gone). When you are reading about "Sybyl," it's fascinating to see what the psychiatrist thought about her behaviour and how dysfunctional it was; when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is. At any rate, I've rambled, but my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.

 

Re: Medical Records and Toby

Posted by DL on March 23, 1999, at 22:33:30

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

Hey Toby,--are you still having problems with this site? I have really missed your input. Am still hangin in there waiting for that appt in April.. Any comments on Q's below?

>>when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is.

This is true. We all create our own life story--by selectively attending to some things and ignoring or repressing others. At times this is a protective instinct and allows us to survive overwhelming times. I can imagine that if I were to read records from 2 years ago (when I was not sleeping at all and in an abusive situation)--written by someone who could see objectively all that was there----I don't know if my self esteem could survive it.

But, I am still curious to see somethings:
--I never saw a treatment plan--yet I saw a therapist for a few years. I know now that insurance co's require them. I would like to see if there are some in my records.

--I saw a psychiatrist every few months during the same time. He usually wasn't sure who I was when Icame in after 8 wks or so. I know once he forgot to write down a prescription and it caused all sorts of problems for me when he was away...Ususally he just asked me what script I needed. .I wonder if he put anything in his records? There was always another pt. immediately after me. I'm curious just to see if there are records!

--Is it ok to ask the new therapist to discuss the records being sent to her--with me?

QUESTION:
--Still have that extra weight. Not good for self-image. Doesn't want to leave me. You gave me suggestions before, but MD was not interested. I have 2 names from the new therapist-to-be for MD's and may call and switch. Knowing my sensitive system, any ideas for me to take to a new psychiatrist?

QUESTION:
--Any guidelines on how long to take Remeron? It's been almost 6 mos now. Do you have experience with people who stopped it and continued to sleep well?--and continued with the lower levels of anxiety?

QUESTION:
--My jaw has become very painful. One side only opens enough to talk without pain. Eating can be quite a chore since Ican't open far enough for a sandwich etc. unless I squish it. If I force it to open more it is so painful--including right into my ear, and just locks up. Always had some off and on "hitching" there but not painful until a few wks ago. Is this just stress? The REmeron seems to help with mental stress but not physical stress.--Not sure who you go to for this if it continues.

>> my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.

If you use the perspective that all psychiatrists are as caring, knowledgeable, up-to -date, and attentive as you, then this applies. however I suspect there are some psychiatrists out there (like the one I have seen for the past few years?) who don't fit that description and for one reason or another are not able to be ethical or reasonable or helpful????

Is there some form of peer review for psychiatrists and therapists?

 

Re: Medical Records and Toby

Posted by Ruth on March 24, 1999, at 20:28:13

In reply to Re: Medical Records and Toby, posted by DL on March 23, 1999, at 22:33:30

A few thoughts. It is reasonable to ask your psychiatrist what information he/she is sending to the new therapist. I'd probably put it in terms of wanting a perspective on where he sees things in your treatment at this point. Thats probably much more important than seeing the written word.
As for peer review, private practitioners don't have a peer review mechanism, although some of them, especially when they are beginning have regular consultaltion.

> Hey Toby,--are you still having problems with this site? I have really missed your input. Am still hangin in there waiting for that appt in April.. Any comments on Q's below?
>
> >>when it's about you, it isn't the same, no matter how intelligent you are, no matter how mentally healthy you've become, no matter how technically unemotional the report is.
>
> This is true. We all create our own life story--by selectively attending to some things and ignoring or repressing others. At times this is a protective instinct and allows us to survive overwhelming times. I can imagine that if I were to read records from 2 years ago (when I was not sleeping at all and in an abusive situation)--written by someone who could see objectively all that was there----I don't know if my self esteem could survive it.
>
> But, I am still curious to see somethings:
> --I never saw a treatment plan--yet I saw a therapist for a few years. I know now that insurance co's require them. I would like to see if there are some in my records.
>
> --I saw a psychiatrist every few months during the same time. He usually wasn't sure who I was when Icame in after 8 wks or so. I know once he forgot to write down a prescription and it caused all sorts of problems for me when he was away...Ususally he just asked me what script I needed. .I wonder if he put anything in his records? There was always another pt. immediately after me. I'm curious just to see if there are records!
>
> --Is it ok to ask the new therapist to discuss the records being sent to her--with me?
>
> QUESTION:
> --Still have that extra weight. Not good for self-image. Doesn't want to leave me. You gave me suggestions before, but MD was not interested. I have 2 names from the new therapist-to-be for MD's and may call and switch. Knowing my sensitive system, any ideas for me to take to a new psychiatrist?
>
> QUESTION:
> --Any guidelines on how long to take Remeron? It's been almost 6 mos now. Do you have experience with people who stopped it and continued to sleep well?--and continued with the lower levels of anxiety?
>
> QUESTION:
> --My jaw has become very painful. One side only opens enough to talk without pain. Eating can be quite a chore since Ican't open far enough for a sandwich etc. unless I squish it. If I force it to open more it is so painful--including right into my ear, and just locks up. Always had some off and on "hitching" there but not painful until a few wks ago. Is this just stress? The REmeron seems to help with mental stress but not physical stress.--Not sure who you go to for this if it continues.
>
>
>
> >> my point is that psychiatrists do many things that patients do not understand and may not like; that's the nature of the treatment of the mind but that does not make those actions unethical or unreasonable.
>
> If you use the perspective that all psychiatrists are as caring, knowledgeable, up-to -date, and attentive as you, then this applies. however I suspect there are some psychiatrists out there (like the one I have seen for the past few years?) who don't fit that description and for one reason or another are not able to be ethical or reasonable or helpful????
>
> Is there some form of peer review for psychiatrists and therapists?

 

Re: Medical Records

Posted by Elizabeth on March 24, 1999, at 21:46:49

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

It seems people are getting the idea that it's generally okay for a therapist, without any particular justification, to deny a patient access to his or her medical records. It's not, and it may even be illegal, depending on where you are.

The law in Massachusetts on this depends on the practitioner involved. A private hospital must provide a copy of the record to the patient or the patient's representative (legal guardian, etc.) (although they may charge a *reasonable* fee for it). A state hospital is only required to make the record available to a patient under certain specific circumstances (e.g., the patient is suing the hospital). A private therapist must give the record to the patient unless the therapist has made an honest and specific judgment that it would be harmful to do so (for some particular reason). In this case, the therapist still must provide a copy to the patient's attorney or a psychotherapist of the patient's choosing, and also give the patient a "summary" of the record.

Toby says:

>Paternalism and ethics are not mutually
>exclusive concepts. Paternalism is
>defined as doing something for someone's
>benefit without that person's consent.
>This is the concept that governs
>guardianship, parenting, and involuntary
>commitments.

More precisely, paternalism means doing soimething that you believe is for someone's benefit that is *contrary to their wishes*, not simply without their consent. It should be regarded as a necessary evil, not something to be practiced on a whim.

The examples you give are acceptable only because the people who are having decisions made for them are considered incompetent to make the decisons themselves, by virtue of age or mental status. You cannot simply assume that any person who has at some point been a psychiatric patient is therefore mentally incompetent.

>With regard to allowing a patient free
>and unsupervised access to their
>psychiatric record, there is obviously
>a paternalistic aspect since the therapist
>is presumed to have knowledge that the
>patient may be incapable of understanding
>or, in the therapist's judgement, may be
>better off not knowing, but as Dr. Bob
>said, ethics would dictate that if the
>record is opened to the patient, the
>therapist should be present to discuss
>those issues with the patient.

Umm. Certainly a therapist (or a medical doctor) ought to *offer* to go over the record with the patient. This is a different question than whether it is justifiable to withhold the record from the patient altogether or to *insist* on reading it with the patient.

>The previous statement may offend
>many who read it here, since most
>folks who can operate the internet
>are fairly well educated and believe
>that they know just as much as any
>therapist or psychiatrist when it
>comes to their own mental illness.

Most of us know what we don't know, actually.

In any case, a psychiatrist (or "therapist") ought to be held to the same ethical standards as any other health care practitioner. If anything, psych records are easier to read than other medical records, so I really do not believe this argument holds water.

Since you seem to need a reason why anyone would want to see their records, here's an obvious one: for many people with chronic illnesses, understanding the illness intellectually is a coping mechanism. (A healthy one, at that, as long as it doesn't grow into an obsession - wanting to read one's own medical records is not, IMHO, an obsession.) Nothing to do with juicy details.

Insurance companies often ask to see patients' medical records. I find it hard to believe that, in general, you think it's perfectly fine to show something to an insurance company that you can't show to the patient. Many therapists don't even keep detailed records (much less records containing what might appear to be "malicious gossip"), out of respect for confidentiality, for the patient's privacy (they don't want the HMO to be reading all about a patient's personal life, and maybe they also don't want to have a document that can be subpoenaed by a court of law). They note a diagnosis, treatment plan, and their justifications for same, but little more than that beyond keeping track of progress and changes.

There's something I don't get: if something is too embarrassing for you to tell a patient, why put it in the record, a legal document, and not, say, your personal diary? (If embarrassment is not what you hope to avoid by withholding a record from a patient, you may wish to provide an example of something that would be harmful for a mentally competent patient to read and that you would put in his or her medical record.)

As a side note, I've read some of my own records. I've never come across anything that looked remotely like "gossip" (and no, this is not just because my life is boring!). I can't think of any circumstance in which it would be necessary to write a psych record in a way that would sound like malicious gossip. If you can, feel free to provide an example of this also.

 

Re: Medical Records

Posted by Dr. Bob on March 24, 1999, at 22:03:51

In reply to Re: Medical Records, posted by Toby on March 23, 1999, at 15:39:44

> Paternalism and ethics are not mutually exclusive concepts.

This is important and not always appreciated. Paternalism has a bad name, but there's a place for it.

> many folks understand the need for experts, but want to be privy to all the juicy details that the therapist may write down...

Sorry if I'm repeating myself, but IMO therapists should think twice before writing down anything "juicy". This being one reason.

Also, feelings about the therapist or the therapy often underlie the wish to see the record, and those should of course be discussed and not just given in to.

> it's like wanting to see all the fluids and fat from your liposuction

Toby, thanks *so* much for such a vivid image. :-)

Also

 

Re: Medical Records

Posted by Elizabeth on March 28, 1999, at 2:04:48

In reply to Re: Medical Records, posted by Dr. Bob on March 24, 1999, at 22:03:51

> Paternalism has a bad name, but there's a place for it.

This is surely true, but there's something wrong when it's considered to be generally okay rather than an occasionally necessary evil. It should be the exception, not the rule. If anything, this is especially true of psychiatry - a "doctor knows best" attitude tends to foster dependency, which ought to be avoided.

> Sorry if I'm repeating myself, but IMO therapists should think twice before writing down anything "juicy". This being one reason.

Also for simple privacy concerns. It's perfectly fine to put this stuff in your diary or something, but a medical record is no place for it. I'm not sure exactly what sort of salacious details Toby was thinking of, but to write them in someone's medical record, a legal document (!), seems unprofessional to say the least.

 

Re: Medical Records

Posted by Elaine on March 28, 1999, at 17:51:18

In reply to Re: Medical Records, posted by Elizabeth on March 28, 1999, at 2:04:48

> a "doctor knows best" attitude tends to foster dependency, which ought to be avoided.
>
>> How does a professional having private records foster dependency? Sometimes it's for your own good. ESPECIALLY in psychiatry - someone with emotional problems can more easily misinterpret something than anybody else. Sometimes there are things that can be shared, sometimes it is best that it not be.

>
> It's perfectly fine to put this stuff in your diary or something, but a medical record is no place for it. ..to write them in someone's medical record, a legal document (!), seems unprofessional to say the least.

A doctor can't be expected to remember everything. If something particular about a patient needs to be remembered, the medical record is the appropriate place. A professional can't keep a secret diary. Perhaps only sketchy notes could be made, just enough to remind him/her without being explicit. A doctor or therapist must be allowed to do his/her job, not have his/her primary concern be what may be discoverable. As an insurance adjuster and as an individual, I believe the current trend of "everyone has every right" and "let's sue if something goes wrong" has gone far overboard. Everybody has their hands tied behind their backs these days because they're afraid of being sued. Personally, I prefer that my doctor be reasonably allowed to do his/her job, even if it means making notes relevant to me, rather than getting me mixed up with another patient because nothing can be written down! As a patient, I am going to a doctor or therapist because I need help - I cannot do it myself - THEY ARE THE EXPERTS even though therapy is a joint effort. They DO have training and experience that I do not. Just because a lot of their notes are in a language I can understand, rather than technical language like a scientist or computer programmer, doesn't mean I have a greater right to access and *try* to correctly interpret them. As I have stated before, a good doctor or therapist would discuss their impressions, your progress, etc. - as long as they are willing to talk with you, why do you need to see exactly what they write? I think they need to be cautious, but do their job considering the majority rather than the occasional record that is subpoenaed, as long as they are ethical in their practice.

 

Re: Medical Records

Posted by Elaine on March 28, 1999, at 17:59:00

In reply to Re: Medical Records, posted by Elaine on March 28, 1999, at 17:51:18

An addendum to my prior message: In case you misinterpret, I really do not believe in being an ignorant patient or consumer. I believe you need to know enough about your doctor to develop the trust you need to. And, in my profession, I have learned not to put doctors or lawyers on a pedestal and think everything they say is right. I do believe in being an informed consumer, but I also believe in allowing a professional room enough to work.


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