Wednesday, December 20, 2006

The Secretary Who Couldn't Stop Talking

[posted by dinah, enough suicide, enough anti-depressants, enough sex offenders]

My confabulated friend is a dermatologist who somehow works all day in spiked heels. Her confabulated mother has a long history of depression and has needed psychiatric care for many years; the situation has been complicated by the fact that the mother now has a progressive dementia, and my dermatologist friend has to take mom to her psychiatric appointments. Because the mother is no longer a reliable observer of her own behaviors, my friend on her heels goes in for at least part of every session.

She imagines that the psychiatrist treats her a little differently because she is a physician: he discusses the mother's behaviors, diagnostic issues, medication regimens in doctor-speak and he chats with her just a bit. He is, however, both friendly and formal, and he honors with my friend all the same boundaries that he would honor with any family member of any patient. He makes a point of asking how my friend is at every session, of giving her a chance to talk about how difficult it is on so many levels to deal with her mother's decline. So the high-heeled dermatologist likes the psychiatrist and feels he is taking good care of both of them, even if she's not the identified patient.

This morning, the psychiatrist was running late. Mom had to go to the restroom, and my friend was left in the waiting room with psychiatrist's secretary: a woman who makes everything just a little more complicated then it needs to be and who has a fondness for talking. No, she didn't pull out her moles, but she did begin to talk about Dr. Shrink's life, how he was running late because he was meeting with his divorce lawyer, that he'd had a brief affair but it was all in the past and his wife was divorcing him anyway, and the custody battle for the 2 cats (placed her for Clink) was a nightmare. "But Dr. Shrink doesn't want anyone to know this so don't tell him I told you," the secretary finished. Mom returned from the bathroom, Dr. Shrink finally arrived, the appointment went without event, but my friend was uncomfortable the whole time.

She kicked off her shoes, at long last, and began to tell me about her discomfort. She realized that she'd quietly harbored the idea that Dr. Shrink led a perfect life: All Gone. She saw him as someone trustworthy and honorable, and she didn't need to know he'd had an affair. But most of all, she was angry with the secretary for imploring her not to tell. Of course there was no legal issue of confidentiality here, my friend owed the secretary nothing, but she wondered if the secretary couldn't respect her boss's privacy, would she respect her mother's? And shouldn't she tell Dr. Shrink that his secretary was blabbing about his personal life--of course she should--but did she want to feel responsible for someone being fired? And how would she continue to deal with the blabbing secretary if he didn't fire her? Would mom's medicare forms suddenly not be filed correctly? Would it be even harder to get scheduled in to see Dr. Shrink? Could the dermatologist simply knock her on the head with one of those spike heels and be done with it?

I've been plagued with a non-confabulated version of this story for the past few days. Clink? Roy? any insights?

With thanks to Victor from my Fiction Techniques class for the use of his high-heeled dermatologist. No skin off anyone's back.


ClinkShrink said...

Dr. Dermatologist definitely needs to tell Dr. Shrink that secretary is blabbing. And she should tell the secretary herself that she feels uncomfortable knowing these things about her doctor. Let the chips fall where they may. Goodness knows how many other patients or their families have now heard all Dr. Shrink's personal business.

And I think Dr. Shrink should get to keep the cats.

Dinah said...

Thank you for your input, venerated ClinkShrink.

Dr. Dermatologist feels very uncomfortable and is angry about being placed in such an awkward position: "I take Mumsy to a headshrinker so we will have less problems, instead we have more problems!" And with that she throws a shoe ($250/pair, Italian, lovely but for those damn heels). She is thinking about telling Dr. Shrink but does not feel she should be burdened with the discomfort of ever seeing, much less ever speaking to, Blabbing Secretary in clogs, no less, again. The cats go barefoot with grace.

Dinah said...
This comment has been removed by a blog administrator.
Steve & Barb said...

Either Derm tells Shrink personally (and ASAP), or sends an anonymous letter stating that she is uncomfortable with having her identity known, "but I overheard your secty saying this-and-that about your personal life to someone in your waiting room, and it made me feel real uncomfortable."

Obviously, Secty needs to be sacked (I'm trying to be bilingual here). She is unable to maintain confidentiality and has poor judgment... neither are assets in this line of work.

Taking another angle here, Secty appears to have little respect for Shrinks' philandering ways, to be angry about having to explain his lateness to annoyed patients, and to enjoy bursting pt's/family's bubble about how great Shrink is. ...Or maybe Secty is trying to play matchmaker for soon-to-be-single shrink and Gucci-Derm.

HP said...

I'd like to think I would have said something at the time to Ms. Blabber to halt the disclosure but easy to say when you're not really in that position. Even if I had done that, I'd still have to say something to Dr. Shrink because apart from discussing the soap elements of his life, I'd be concerned about what she was blabbing about mine!

ClinkShrink said...

Ah, we are all sometimes burdened with the presence of obnoxious people. I'm sure Derm Doc has a few difficult folks to deal with in her own practice and off-duty life is no less challenging. I suspect that Ms. Blab will be appropriately sedate now that she has had a shoe thrown at her, especially one of those with the really big cluncky heels that are so popular now (I'm waiting for that fad to pass).

And I think "The cats go barefoot with grace" would make a terrific first line to a poem.

Dinah said...

No, no, clink, Dr. Derm threw the shoe at ME, or maybe at the wall, not at the secretary.

Healthpsych, friend contends that she attempted to shut down secretary but was spoken over.

Roy: don't get too bogged down on detailed analysis here, the facts of the story are fictionalized beyond recognition by all involved.

Thank you all for your input, please feel free to continue!

Dinah said...

The cats go barefoot with grace.
Clink says "ha...chew!" to their
She's allergic, you know,
To cats on the go,
A fact that remains a disgrace.

Did you need more?

Anonymous said...
This comment has been removed by a blog administrator.
Anonymous said...

Chinese beauties make their feet little,
A specific fetish of Oriental acquital.
When you meditate on the tilt
Occidental heels give the pelvis,
And the grace with which cats go shoeless.

Steve & Barb said...

The cats go barefoot
With grace they lounge in the sun
Arched back contentment

ClinkShrink said...

Ah, poetic beauties one and all. Thanks everybody.

Midwife with a Knife said...

I'm just curious, if the secretary were your secretary and blabbing your personal information like this to your patients and/or their families, what would you do? Would she get a warning or just fired?

Medblog Addict said...

I don’t know what the doctor/secretary relationship is like, but if it is anything like a lawyer/secretary relationship, then Dr. Shrink already knows Secretary is a blabber and he has chosen to do nothing about it. Especially if they’ve been working together for a long time. There are no secrets in our office. But it may be different in a one-woman office, or a doctor’s office. I am flying blind here.

My question is: Wouldn’t it be counterproductive for her (and her mother) to continue to see a doctor that makes her uncomfortable? If it’s something she just can’t overcome, shouldn’t she explain what happened and then fire him? Or is that impractical?

Maybe she should just ask him if he has any cats and see where the conversation goes from there.

Fat Doctor said...

Derm to tell Shrink. Now. Shrink should fire Secretary. Now. But for the love of all things holy, don't tell her there's an opening in our office. We have enough verbal diarrhea around this place.

Dinah said...

Ok, is anyone still here? What if I change my confabulated scenario? What if the thing the secretary blabs to Dr. Spike Derm about is something personal about Dr. Shrink, still with the caveat "He doesn't want me to tell so don't tell him," but not damning to character, something personal but maybe he really wouldn't be that upset, like that he was in traffic court, or was running late because his wife had complications after her face lift?
Would you feel ANY differently?
Clink, I know, still fires her and lets the cats land where they may (extra lives anyway). No poetry here, please.

Fat Doctor said...

No, Dinah, I wouldn't feel differently. A doctor's relationship with the secretary is one of trust. If the thing she blabbed was even remotely personal, it could disrupt the patient's relationship with the physician. The physician should be the one to decide when, and if, and how much personal information is to be divulged over time. For some patients, I am very honest when asked questions about my personal life, for example. With other patients, for completely therapeutic reasons, I choose to leave my personal life completely out of our relationshis. If the secretary isn't fired, she should at least be sternly warned and put on some form of probation.

DrivingMissMolly said...

As a PT, I am hyperobservant of the entire doctor's office experience. Dr. McShrinky has a lovely polite and professional secty who I gifted with a small box of Godiva chocolates at my last visit Dec. 20th. I'm aware of the power of the secty, but I genuinely like her and would rather spend the hour with her ;)

Since I arrived super early, instead of sitting in the tiny waiting room of shrink (academic shrink), I sat in the larger psych dept waiting room where I observed a secty/receptionist complain that "there was no one back there" (referring to shrink's office). She was frustrated and angry. I was bemused, especially by another secty's annoyed reaction.

The woman in Dinah's "confabulated" scenario if not fired, needs to be reassigned at a position that does not require good judgment and discretion.

If I were to find out said things about Dr. McShrinky, who I hate to admit a growing attachment and affection for, I would be shattered at this early stage in the game.

Lily (who is questioning her evil and dark motives for telling wonderful secty about a job opening in law in her city).

PG said...

I don't think I would have been comfortable saying something "in the moment".

I am curious what Dr. Dermatologist would think if it were her own secretary revealing relative information about the doctor to patients.

This is definitely a threat to the doctor's face and I do not blame Dr. Dermatologist for her frustration for being caught up in this. I think she will feel better when she decides if she will continue seeing Dr. Shrink (or not) and whether she will inform Dr. Shrink of his secretary's indiscretions.

I think the consideration is whether knowing this information impedes further care and whether patients' privacy rights are at risk.

Anonymous said...

The pharmacist and future 25% of a doctor in me says: Even with the reconfabulated scenario, if I were Dr Shrink, I would want to know what Blabs the secretary is saying - there are plenty of ways to explain the lateness of a doctor/anyone that don't involve telling the whole gory truth.

eg. "Dr Shrink has called to apologise that he's running late - he'll be here in X minutes"


"Dr Shrink went to the supermarket to buy some last minute egg nog three hours ago. He should be at the front of the checkout queue any minute now".

From the Dr Shrink patient perspective: if there are any personal experiences that my psychiatrist has had that he feels might be helpful to my care, it is up to him to tell me. If he wishes to tell me anything about his personal life then it is up to him to tell me. I trust him not to burden me with his problems - that is the exact opposite of the shrink/patient relationship.

Although Dr Derm is not the official patient, she is in a way, a patient of his as well. If she were a paid carer, while it would still be inappropriate for Blabs to Blab, hearing that information would not be so much of a problem. But this is her mother! Regardless of the truth, we all want to believe that our relatives are being looked after by paragons of virtue. And the trust we put in a shrink can be enormous.

Eh getting too long. But summary:
* Dr S needs to know about Blabs.
* It would probably be helpful for Dr D if Dr S knew what Dr D knows.
* What Dr S did or did not do is not the issue in this scenario. It's not relevant to his treatment of Dr D's mother. HOWEVER she shouldn't be in a position of knowing about it in the first place. And now that she does know, her perceptions of the trustworthiness of Dr S have been shattered.

Anonymous said...

As a random passerby, my untrained lay opinion...

Secretary is setting Not Quite Patient up against Shrink, by handing over a secret about Shrink and asking them not to tell.

NQP then has to trust to break trust with the Secretary, or to keep mum and break trust with Shrink.

That's a horrible position to be in. NQP gets a place in a war and has to chose sides. That's not what NQP is there for, because the relationships are not personal, monkey-society relationships, they're professional.

Secretary is therefore unfairly bringing NQP into the monkey-circle of Shrink, which is inappropriate. NQP has been wronged. Even if it was just that Shrink takes two sugars in their coffee and pretends to only take one, it's still wrong to pass this on and demand complicity in the secret-sharing.

Whatever NQP then does with the information is immaterial, because the hurt cannot be undone. Forcing someone to make that decision is an insult and an affront.

Anonymous said...

SuperMouse is right on target with Dr. Spike Derms unwanted dilemma.

To all that suggest ditching Dr. Shrink, Dr. Derm says that's not in her option list: Mom has been going to him for years, and with the added issue of dementia, she would neither understand the situation, nor would she easily adapt to a new doctor. I forgot to mention that it's a genetic thing that demented mom still wears spikes and throws them at any new docs.

I haven't talked to Dr. Derm in a bit, I suppose I'll post when I hear what happens.

Patient Anonymous said...

A little late to the party but...

Something similar but different(?) happened just recently to someone I know re: the unprofessional comments of a receptionist in a doc's office and you have to say something.

That's it. Plain and simple.

If the "blabbermouth" is saying A, then she's probably saying B, C, D and the rest of the alphabet and then probably everything else right up on up to Vulcan and/or Klingon. No probably not Vulcan--they weren't prone to gossip, too logical.

Anyway, regardless of the information, confidentiality is confidentiality. It doesn't matter what is being said.