Wednesday, May 07, 2014

Privacy versus Necessary Communications

Greetings from New York.  All the Shrink Rappers have been enjoying the APA meetings these past few days.  

Today's post is located over on the Clinical Psychiatry News website: Legislation's privacy exceptions of psychiatric patients are concerning.  Do surf over and read the post there


Anonymous said...

I do not want my psychiatrist discussing me with anyone without my consent, and this includes my parents. If this legislation passes, I predict patients will no longer feel comfortable sharing much of anything with a psychiatrist. I know I would not. I do not want my psychiatrist discussing me with my family, even in an emergency. I love my family, but I want my privacy respected.

If legislation like this passes, I doubt I will continue seeing a psychiatrist. This legislation will wreck the therapeutic alliance.

I have been following this legislation for a while, and my first thought when I read it was that if this legislation had existed years ago I would never have seen a psychiatrist. I would not have felt comfortable sharing anything.


Anonymous said...

One thing that just boggles my mind about this legislation is that a psychologist is behind it. Does he know anything about patients? Does he think patients will put up with this breach of their privacy? I just cannot imagine very many patients putting up with this.


Dinah said...

P-K, The intent of this law is not to disclose the content of therapy sessions to family; psychiatrists and therapists would never want that and there is nothing in the law that forces that, it's about disclosing for the best interest of the patient.

This law is about when a family takes a patient to the ER, there are no beds, and the patient gets sent to another hospital. The family then calls the hospital to see how their family member is and the receptionist says "I can't tell you if they are even here." Or when a patient gets discharged, to let the people he's living with know what prescriptions need to be refilled and what followup appointments are needed so there isn't a relapse. Most of the time, I believe this information is not shared because it takes too much effort to hunt the patient down and say, "look, call your family and tell them you are here." Or it's easier to just discharge to the street then to get consents signed and coordinate all the details.

Psychiatrists have no interest in chasing down family members to gossip, or to injure the doctor patient relationship by having someone feel betrayed. It's about locating family and discharge instructions when someone needs help negotiating such things (and not when they don't).

But you are right that the wording of the bill is such that there can be unintended consequences.

jesse said...

"the caregiver shall be treated by a covered entity as a personal representative [of the patient]... when the provider furnishing services to the individual reasonably believes it is necessary for protected health information of the individual to be made available to the caregiver in order to protect the health, safety, or welfare...."

It is already the law, and established under Tarasoff, that the doctor can not ignore consequences, has to protect innocent individuals, and can talk to others in certain circumstances.

What is left out of most discussions is that the patient can explain to the doctor the family situation. So P-K you might explain to your psychiatrist, with whom you have a good relationship, the situation and the two of you can work out how to handle emergencies. There is no need at all to distrust psychiatrists if the law allows them to speak with family as long as your doctor believes it is necessary to protect your health, safety, and welfare." This actually makes it more likely your wishes would be followed.

There can always be unintended consequences. I suspect many patients were more hurt than helped by those "We can't talk with you" rules.

Anonymous Liz said...

i'm so confused- why can't the psychiatrist simply get a signed release allowing them to speak with family... the same release that enables them to release records to another care provider? and if the patient does not want their information to be released, then just respect what the patient wants, wince they are the patient and it is their health information? i've always been open with my family about my psychiatric treatment and feel that has really benefited my healing and my relationship with my family. my family had more difficulties getting information to or from my treating physician WITH my signed consent. still, i HATE to see liberties stripped away from an already vulnerable group. this legislation is disturbing.

Anonymous said...

The thing is I don't even want to have to worry about what might or might not be said, just the fact that this legislation would permit my psychiatrist to talk to my parents without my permission is very disturbing. I will definitely talk to my psychiatrist about this and make clear that he does not ever have my permission to talk to my parents. I understand Tarasoff, and I have not made nor would I make any threats against anyone so I have nothing to worry about there, but this legislation pretty much lets a psychiatrist say whatever they want to a patient's parents. I don't want that. I don't think most adult patients would appreciate having their privacy breached without their permission.

I just don't want my parents involved in my psychiatric treatment. I'm 41 years old, and I don't need mom and dad all involved in what medications I choose to take or not take. I also wouldn't want them involved following a hospital discharge, as I think that would only make things more stressful for me.

It's terrible legislation. It treats psychiatric patients like they are less deserving of privacy than patients with other illnesses. I really hate to see psychiatric patients treated like small children, and that is what this legislation does.

A psychiatrist (or therapist) should ask the patient for his/her permission to speak to family. If the patient says no, then respect that.

If a psychiatrist destroys trust, the patient will not return for further treatment. Hopefully, if this legislation passes, they will keep that in mind.


ILuvCats said...

I'm with Psuedo-Kristen about not discussing issues with family unless the doctor gets my permission first. In my experience, the psychiatrists refuse to call my spouse when asked, though. I guess they don't want to know what I'm like normally - just want to think of me as always being at my worst? They won't even talk to my regular psychiatrist or my therapist when requested. Only once has one called my spouse. Ever.

I wish there was a generic release that immediate family members could use at various places, instead of having to sign a release for each place. That way, a caregiver person could have the patient sign ONE form ONCE a year so there is a release in place, and keep it on hand for emergencies. I have been caretaking for someone else who has trouble taking care of his/her affairs, and has incredibly complex health problems, and there have been like 6 places we had to get releases for. It's about due that I have to get the paperwork and have my relative sign all that stuff again, just so I can help with appointments, getting records sent to other places where care is transferred, etc. I suppose the places will all have their own special form, too. I don't read the records (although legally I can get them and read them, but that would be a breach of privacy) but I need the release in order to help the relative access care. This person is competent, so it is inappropriate that I take over their health care altogether, just help my relative access the care, and the help is extensive. *Extensive.* The releases are a problem.

ILuvCats said...

I again agree with Pseudo-Kristen about treating mental patients like children. there are people with very serious health problems of all kinds whose caregivers are impeded by the problem with signed releases. there needs to be a LEGAL FORM for each state that will cover this - something other than a health care power of attorney, for patients who are competent but may be in and out of serious illness and therefore their caregiver needs to be able to make appointments, get records transferred etc. on their behalf, but not take over their decisions altogether.

Sarebear said...

I can see some of the good they are trying to do, and I can see some of the bad this could end up or start to.

I don't really know what a good answer or solution would be but I don't think this bill is it.