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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by pseudoname on April 29, 2006, at 23:15:41
This probably isn't interesting to anyone but me, but I just got my records from 2 of my former pdocs. The records match my impressions of them.
“This very interesting 38-year-old man…”
VERY interesting? Why VERY? This was from a pdoc-in-training at a major university clinic.
For every appointment he wrote:
“Mr. _____ arrived 10-15 minutes early for the appointment. He is neatly dressed and well-groomed. He is thin and very pale. His eye contact is furtive. His speech is soft but spontaneous. His insight is fair.”
(Just fair.) That sounds very detailed, but he used the exact same wording for every appointment.
“It will be interesting to determine how much of his social isolation is driven by his depression and how much is driven by social phobia or avoidant personality.”
Why? Why would THAT be interesting? I was interested to know if we could treat my depression at all. His attitude seems twisted to me, like how you'd think about an unusual infection. At the time, I thought this pdoc suffered severely from “medical model” problems, thinking that mental health problems can be classified and attacked like funguses. It's disconnected from real life and common sense. On the basis of a 20-minute interview every 2 months, how could he ever hope to sort out how much of my social isolation was due to his vague, conjectural disorders and how much was due to “depression”, whatever that's supposed to be. “Avoidant personality” isn't a chemical you can measure into a beaker. I like what med_empowered said: personality disorders are moral judgments with code numbers.
“We have recommended very strongly to him that he pursue a course of ECT. He was strongly opposed to this recommendation and essentially left the clinic in Sept 2003.”
I'm glad he was able to put that together: I left because all he talked about was ECT, despite my strong, detailed, even tearful objections. But he's using the royal “we”. There was no one else there, it was just him.
In the notes of every visit I had with him, he insists on ECT and writes down my strong objections. And it never sinks in. There's even a handwritten (and human) note from the nurse: “FYI— Patient expressed a lot of frustration about your ECT recommendation.” But it didn't slow him down. He had ECT on the brain.
The depth of his psychological understanding is shown here, in the PRESCRIPTION part of the summary: “3. I encouraged Mr. _____ to force himself to get out of his house at least once each day.”
Brilliant. Force myself. I never would've thought of that. He even put in the quantity: q.d.
My other ex-psychiatrist, in a private practice, wrote this at our first appointment:
“Insight poor. Judgment poor.”
Ouch. Not even “fair”, LOL. She also said, “He is a very short man.” I dunno... I'm 5'8".
At our last appointment she wrote:
“He looks through the internet, he talks a lot about neuro-receptors…”
I don't know much about receptors, so I doubt I said much.
“…he wants to try something called Nelaxon…”
It was NALTREXONE. Jeepers! Did she have no idea what we were talking about?!
“…which he said in the internet has helped with persistent depression.”
At Babble! Later I got naltrexone from someone else; it didn't work.
It's sad to see so much consistency over years of appointments. Nothing helped, nothing helped, nothing helped. Such brief, superficial notes, but they say so much. In the future, I think I may ask for a copy of the notes after every appointment.
Posted by med_empowered on April 29, 2006, at 23:21:51
In reply to Got my psych records, posted by pseudoname on April 29, 2006, at 23:15:41
wow...I've thought about requesting my notes from various docs, but I can't imagine what they would say (I'm picturing "anxiety-ridden and sarcastic").
From notes I've seen, though, it seems like ever session involves lots of superficial observations that the doc then loads with meaning, I guess b/c if they (the doc) notices something, it must be important (since they are a doc). For instance, I was reading a case study once and the doc noted "27 year old male..already losing his hair...". OH MY GOD! What does androgenic alopecia have to do with mental health??
Anyway..thanks for posting, and good luck.
Posted by Phillipa on April 29, 2006, at 23:48:58
In reply to Re: Got my psych records, posted by med_empowered on April 29, 2006, at 23:21:51
Mine would only release them to another pdoc. Or you can request to read them with the doc present. Love Phillipa
Posted by pseudoname on April 30, 2006, at 0:30:33
In reply to Re: Got my psych records, posted by Phillipa on April 29, 2006, at 23:48:58
Hey, Phillipa.
> Mine would only release them to another pdoc.
I guess laws vary state to state.
Once your current doc gets them, maybe you could get copies then. All the earlier docs' records were included in what my last pdoc's office sent.
If a doc refused my request, I would sue. I'd love it! ;-)
> Or you can request to read them with the doc present.
How insulting. But I'd settle for that, if I could get copies after. Looking over some state laws just now, I guess they can hold records back if the info in them would cause “a severe deterioration in mental state” for the patient. Even then, there's an appeal procedure, and you can also file to get a court order. But that seems like a pretty far-out situation. Whatever that info is, why hasn't the doc broken it to the patient already?
Posted by Racer on April 30, 2006, at 11:01:42
In reply to Re: Got my psych records, posted by med_empowered on April 29, 2006, at 23:21:51
It was an educational experience, but at the time, it nearly sent me over the edge. For anyone who remembers, this was The Agency From Hell, so what was written had little to do with what I experienced in those rooms. And I don't think that means I'm delusional...
My favorite, though, was the pdoc's little MMSE, which is the part where they write, "39y/o WN/WF, grooming good, etc." During the time I'd been under his care -- starting about three months after first seeing him -- I'd lost about a third of my body weight. (Can anyone here maybe think of something that might suggest? Let's see... PT claims history of Anorexia Nervosa... PT claims to feel problems starting with food... Uh, nope, not a thing comes to my mind. She seems perfectly fine to me...)
Flash forward to his notes on me: at the very beginning of my weight loss, while I was still within normal range, his notes say, "39 y/o WF, thin." That's at about 135, on a body that used to be 5'9", so that's pretty OK right there, yeah? The next appointment, by which time I weighed about 110, it's back to "39 y/o WF/WN" -- that is, "39 year old White Female/Well Nourished!" Stayed there after I lost more weight, too. I don't know if he was truly unaware, or if he was trying to cover his butt by NOT seeing it.
Psych records, for anyone interested in seeing theirs, should probably been reviewed with a good T sitting next to you. I'm not kidding about barely surviving reading mine.
Bah. Doctors...
Posted by Phillipa on April 30, 2006, at 13:23:33
In reply to Re: Got my psych records, posted by Phillipa on April 29, 2006, at 23:48:58
Probably a good example of why they don't want you to read them. Love Phillipa ps usually won't although it's within your rights. And a lot of people unfortunately or maybe fortunately don't know their rights
Posted by pseudoname on April 30, 2006, at 14:51:35
In reply to I've read some of mine..., posted by Racer on April 30, 2006, at 11:01:42
> Bah. Doctors...
LOL! I'll throw in with you on that. ;-)
> I'm not kidding about barely surviving reading mine.
Wow. That's a sobering story. I shouldn't discount the effect that records can have.
Concerning most psychiatrists, I think I have such massive, firmly-established contempt and disregard for them, how they practice, and what their “clinical judgments” are, that I would be at worst annoyed or amused no matter what they wrote. I always feel more confident in a psychiatrist's presence, actually, because I think they're so inadequately trained, deluded, & ultimately confused about what they're trying to do that their opinions don't count for much. I mostly just want them to sign the prescriptions I dictate.*
Apparently I cover well, because there's nothing in these records about them detecting a “delusional superiority complex / inferiority issues” etc.
The therapists I've seen, though... Hmm. That would be different. The ones I stuck with I have personal respect for. There could be private judgments there that would send me reeling. I haven't seen those records.
*This wouldn't apply to Dr Bob, of course. ;-)
Posted by med_empowered on April 30, 2006, at 15:28:11
In reply to respecting the source » Racer, posted by pseudoname on April 30, 2006, at 14:51:35
Personally, I don't really considers shrinks "docs"--I have tremendous respect for my over-worked GP, and very little to less-than-none for all the shrinks I've seen over the years. They have their own issues and work in what is largely and Big Pharma-sponsored pseudoscientific exercise in enforcing conventional morality. Yes, some people benefit from psych drugs (that's great)--but anyone can RX those; I don't think many people benefit from dealing with PSYCHIATRISTS themselves.
Posted by pseudoname on April 30, 2006, at 16:52:58
In reply to Re: respecting the source, posted by med_empowered on April 30, 2006, at 15:28:11
> They have their own issues and work in what is largely and Big Pharma-sponsored pseudoscientific exercise enforcing conventional morality.
Well put. Narrow conventions… plus the pdoc's arbitrary personal tastes and bigoted expectations. I think the field of psychiatry *attracts* people who have their own issues, to put it mildly. They like the idea of “being a doctor” a lot more than actually practicing scientific medicine.
This post was originally 600 words longer, with examples, but that pretty much sums it up. (I could write a book.)
Posted by Emily Elizabeth on April 30, 2006, at 17:21:19
In reply to playing doctor » med_empowered, posted by pseudoname on April 30, 2006, at 16:52:58
It sounds like you have had some awful experiences w/ pdocs. I myself have seen 2 very good pdocs, so I know that they are out there. But, I mostly wanted to write to say that it is very unprofessional/unscientific to use words like "interesting" in chart notes. My supervisors (psychologists) would never approve of that sort of thing. "Interesting" is SO subjective and, frankly, irrelevant. Would he describe another patient as "boring?" I hope that you don't take his notes personally. Sounds like he wasn't the sharpest crayon in the box...
Best,
EE
Posted by Racer on April 30, 2006, at 17:25:35
In reply to respecting the source » Racer, posted by pseudoname on April 30, 2006, at 14:51:35
> Concerning most psychiatrists, I think I have such massive, firmly-established contempt and disregard for them, how they practice, and what their “clinical judgments” are, that I would be at worst annoyed or amused no matter what they wrote. I always feel more confident in a psychiatrist's presence, actually, because I think they're so inadequately trained, deluded, & ultimately confused about what they're trying to do that their opinions don't count for much. I mostly just want them to sign the prescriptions I dictate.*
>And that's a big part of the problem for me: I don't have that feeling at all.
In my case, a lot of it comes from trying to get treatment while uninsured and underemployed. I couldn't afford medical care, and getting any sort of psych medications meant showing up for the appointments with cap in hand and tugging my forelock. It doesn't help that I'm female, either. A number of the doctors --
-- you know what, let's leave it at this: I have had a large number of very bad experiences and I am not over them. Trying to tell about them is getting me upset, so the short version:
I feel quite powerless with psychiatrists -- any doctor, really -- and so I can't distance myself the way you do. I can say, "That guy's insecure/arrogant/thinks every woman finds him attractive/etc" but it doesn't translate to making it easier for me to deal with them. And I come by that discomfort honestly.
Posted by pseudoname on April 30, 2006, at 18:10:23
In reply to Re: playing doctor » pseudoname, posted by Emily Elizabeth on April 30, 2006, at 17:21:19
Hey, EE.
> it is very unprofessional/unscientific to use words like "interesting" in chart notes.
I'm glad to hear you say so (or, read you write so). Reading it again, I really think he was just trying to impress his supervisors by puffing up my case so that it would attract more attention. But he isn't even doing that very well. I think most writing teachers would steer budding novelists away from words like “interesting”.
> Sounds like he wasn't the sharpest crayon in the box...
He was at an extremely presitigious institution and had an impressive med school / post grad resume. But he seemed to be very clumsy interpersonally; he reminded me of certain teenage boys. I couldn't understand why someone with apparently so little sensitivity would *want* to be a psychiatrist.
He went on to work at a forensic psychiatric firm. Virtually all the company does is test and testify about competence and the state of others' minds.
So, he won't be working clinically. He'll only have people's freedom in his hands. :-(
Thanks for your reply.
Posted by pseudoname on April 30, 2006, at 18:28:14
In reply to Re: respecting the source » pseudoname, posted by Racer on April 30, 2006, at 17:25:35
I'm glad you posted that, Racer.
I feel powerless, discomfitted, judged, oversolicitous, etc, similar to what you just described, but about virtually everyone EXCEPT psychiatrists. It's almost hilarious but for being so bad. I realized that peculiar exception about 15 years ago.
I feel inferior & annoying with neighbors, Babblers, dentists, store clerks, family members… just not pdocs! Too bad they're so expensive, I'd indulge more often.
Posted by Racer on April 30, 2006, at 19:26:35
In reply to Re: respecting the source » Racer, posted by pseudoname on April 30, 2006, at 18:28:14
I know you're serious, and I hate that you feel that way -- but you make me laugh. Whatever you feel during your interactions with me, I promise, I never find you "inferior & annoying."
In fact, quite the reverse.
Take care.
Posted by Phillipa on April 30, 2006, at 19:37:01
In reply to Re: respecting the source » pseudoname, posted by Racer on April 30, 2006, at 19:26:35
There is a format a pdoc must use in a patients chart. The DSM requires first a primary dianosis Axis I for instance Major Depression. Axid II second on list as substance abuse. Axis III health problems Axis IV and Axis V. I always forget the last two. But subjective terms are not allowed anywhere they must be factual and direct observations by the pdoc. He can't just chart he thinks sometime he has to support his findings. Hope this helps too. Love Phillipa
Posted by alohashirt on April 30, 2006, at 21:22:04
In reply to Re: respecting the source, posted by Phillipa on April 30, 2006, at 19:37:01
I was doing a degree in counseling psych and seeing a therapist. i asked to see my records. Therapist set up an appt for me and her supervisor to read the notes. The notes were skimpy. next session she begins "tell me about why you attacked the therapeutic boundaries?" Was clearly very defensive, hostile. I was puzzled and upset.
Posted by Caedmon on April 30, 2006, at 22:23:14
In reply to My experience, posted by alohashirt on April 30, 2006, at 21:22:04
Were these scribbled down notes or formal SOAP note-type records? I don't understand the nature of the records you are describing.
Maybe I don't understand what the big deal is. I didn't really read anything that I would have felt was offensive, if it had been said of me. Perhaps if I felt it was inaccurate... but then, I'd wonder what it was that lead to an inaccurate perception.
- C
Posted by gardenergirl on April 30, 2006, at 22:47:19
In reply to Re: respecting the source, posted by Phillipa on April 30, 2006, at 19:37:01
Although if they are using the SOAP format for charting, the "S" represents subjective. But I agree, "interesting" serves no clinical utility as an adjective. Unfortunately, I've read lots of psychiatric notes that look a lot like the one presented at the beginning of the thread.
BTW, Axis II also includes personality disorders and pervasive developmental disorders. Axis IV is for psychosocial stressors, and Axis V is the GAF, or Global Assessment of Function.
gg
Posted by capricorn on April 30, 2006, at 22:50:45
In reply to Re: Got my psych records, posted by med_empowered on April 29, 2006, at 23:21:51
OH MY GOD! What does androgenic alopecia have to do with mental health??
Pdocs have that effect on some people. 'Oh no,not another stupid question'?
Client tears at hair in frustration'.
Posted by Phillipa on April 30, 2006, at 23:31:22
In reply to Re: respecting the source, posted by gardenergirl on April 30, 2006, at 22:47:19
gg I remember SOAP subjective, objective , assessment, Plan. They did'nt use them only in the beginning they were always changing the format. Why can't they just stick with one thing. Confusing to say the least. And thanks for Axis IV and V. Love Phillipa
Posted by Phillipa on April 30, 2006, at 23:33:23
In reply to Re: Got my psych records, posted by capricorn on April 30, 2006, at 22:50:45
It doesn't have anything to do with psych unless you do tear out your hair!!!!!Just a joke Love Phillipa
Posted by pseudoname on May 1, 2006, at 12:03:44
In reply to My experience, posted by alohashirt on April 30, 2006, at 21:22:04
> next session she begins "tell me about why you attacked the therapeutic boundaries?"
Mmm. You have a cautionary story. SOMEBODY was crossing boundaries, but it wasn't you.
With my current pdoc, I think I'll bring up the topic of records *generally* — I'll mention some of the stuff the other docs wrote about me, mention your story, etc. I'll ask her what she thinks of clinical notes, what's her strategy with them, etc. Just try to break the ice about it and get her to see that my interest in them is non-threatening.
I'll tell her that I'll probably ask for her records about me eventually, too. Just to make sure she's not alarmed when it happens. But she's pretty laid-back, so I don't think there'll be a problem.
The Care and Feeding of Your Mental Health Professional.
(Actually, I haven't gotten any response from a request for records I put in at one ex-pdoc's office. I wonder what's up with that.)
Posted by bimini on May 1, 2006, at 16:53:19
In reply to Got my psych records, posted by pseudoname on April 29, 2006, at 23:15:41
When docs write reports they must keep in mind that the patient will read them. I have requested copy of reports before first appointment, fill out the release form right then and there. Few docs have given me a cut and paste version, some reports are not suitable for the patient to read. I have written a 'clarification' letter to my pdoc to correct misunderstandings. We both are better at figuring where we are heading, knowing where we are coming from.
One interesting blooper on my Neurologist's report: 'she looks well tanned'. Sun tanned, racial pigment or relevant skin change?bimini
Posted by pseudoname on May 1, 2006, at 17:04:15
In reply to Re: Got my psych records, posted by bimini on May 1, 2006, at 16:53:19
> I have requested copy of reports before first appointment, fill out the release form right then and there.
That's a great idea! I am going to do that from now on. Be very matter-of-fact about it.
> I have written a 'clarification' letter to my pdoc to correct misunderstandings.
I think this is wise. Prosecutors, defense lawyers, insurance companies, etc., can all get access to these files (under certain circumstances). There may be need to correct them, just like a credit report.
Posted by Phillipa on May 1, 2006, at 19:15:59
In reply to Great idea » bimini, posted by pseudoname on May 1, 2006, at 17:04:15
Not only pdoc records all doc records have mistakes. Before we moved we got all docs records. In the ENT one it said Biaxin tasted like chocolate to me. Wrong of course. Love Phillipa
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