tag:blogger.com,1999:blog-26666124.post6666050134959423542..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: On Publishing the Psychiatric Records of Those Who Can't Say NoUnknownnoreply@blogger.comBlogger43125tag:blogger.com,1999:blog-26666124.post-56307039703463648242013-02-13T03:48:30.874-05:002013-02-13T03:48:30.874-05:00Ok, an example RE the morality of the actor vs the...Ok, an example RE the morality of the actor vs the ethicalness of the act.<br /><br />I've just gotten back from Kolkata. There are lots of child beggars. A moral visitor is shocked and is moved to do something. An impulsive moral visitor might give money to a child beggar. That's usually going to be an unethical act because it causes harm, but since the intention was good we don't consider the visitor to be immoral or otherwise not-nice. <br /><br />A thoughtful moral visitor will do some thinking to determine the most ethical way to proceed. They will realize that giving directly to child beggars encourages them to continue to beg; perhaps most crucially, encourages an adult guardian to keep them out of school so they can beg. If children were unable to bring home enough money by begging then they and their families would be forced to seek other options. The question then turns to the other options. What if there aren't any? Well then, that's where your money should be going. There are orphanages, schools for hard-to-reach children and workshops that train and hire single mothers. Give to those. Be a moral/nice person and commit an ethical act. <br /><br />Dinah asked whether publishing the psychiatric records of nonexistent people was an ethical act, not whether someone who committed that act might be a moral/nice person. Maybe it's an act like giving money directly to begging children rather than providing the children and their families with options: understandable but likely to be harmful (and therefore unethical). To know whether it's ethical or not requires thought and discussion of the harms and benefits. <br /><br />Is publishing the records likely to have the desired effect of drawing attention to a neglected problem? (Is the problem actually neglected? Is there more to the story? Have dedicated, thoughtful, caring people been working for decades on a better solution and been unable to find one? Just because the problem is new to those parents doesn't mean it isn't well-understood by others.) <br /><br />Is increased attention likely to result in better care for patients? (Maybe it will lead to ineffective interventions that make onlookers feel like something is being done but which are at best a waste of money, at worst harmful.) <br /><br />Is publishing the records likely to have any undesired effects? (Does it break an implied contract? is it a violation of the principle of autonomy? Will living people refuse to seek medical care because they fear their privacy may be violated after they are dead? Will care providers change their documentation practices to reduce the likelihood of their patients' privacy being violated after their deaths? Will reducing documentation result in poorer care or lower reimbursement? Will lower reimbursement lead to less-accessible care, either because patients can no longer pay for it or because medical students decide against psychiatry and the undersupply problem becomes worse?) <br /><br />These are complex questions and "Hey, the parents meant well" doesn't answer them. Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-86125388737345568642013-02-13T03:42:26.977-05:002013-02-13T03:42:26.977-05:00This comment has been removed by the author.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-53964544793943757252013-02-12T14:42:57.138-05:002013-02-12T14:42:57.138-05:00Thanks, Sleeves.
Substituting morality for sin:
...Thanks, Sleeves. <br /><br />Substituting morality for sin:<br />“The difference between ethics and morals can seem somewhat arbitrary to many, but there is a basic, albeit subtle, difference. Morals define personal character, while ethics stress a social system in which those morals are applied. In other words, ethics point to standards or codes of behavior expected by the group to which the individual belongs. This could be national ethics, social ethics, company ethics, professional ethics, or even family ethics. So while a person’s moral code is usually unchanging, the ethics he or she practices can be other-dependent.”<br /><br />http://www.wisegeek.com/what-is-the-difference-between-ethics-and-morals.htm<br /><br />So according to this definition, sharing the psychiatric records of their nonexistent son might or might not make the <i>parents</i> immoral people depending on their state of mind. <br /><br />However, the <i>act</i> is ethical or not depending on how it affects the larger society.<br /><br />According to this definition, I am really not particularly interested in the morals of the parents. I am much more interested in whether they behaved ethically. Dinah seems not to care whether their behaviour was ethical or not: she’s much more interested in whether the parents are nice people. Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-4305293570964188352013-02-12T14:35:53.583-05:002013-02-12T14:35:53.583-05:00Repenting. I hate auto correct. Repenting. I hate auto correct. Sleevesnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-44231558094460438162013-02-12T14:32:59.066-05:002013-02-12T14:32:59.066-05:00Lol. Mens,not men's . Sin, I'm always sinn...Lol. Mens,not men's . Sin, I'm always sinning and always relenting. I'm on the hamster's wheel. I'll take your god over my god, Alison Sleebesnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2327924876431268662013-02-12T14:29:28.279-05:002013-02-12T14:29:28.279-05:00Alison,
Depends on your religion. Crime generally...Alison, <br />Depends on your religion. Crime generally requires a men's rea. In my religion, no one cares what I intended; actions speak louder than words. Sleevesnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-70679345258157824262013-02-12T08:45:04.425-05:002013-02-12T08:45:04.425-05:00Whether publishing the records of someone unable t...Whether publishing the records of someone unable to consent (because they don't exist) is an ethical act has nothing to do with the intentions of the person who published them. It has to do with the [foreseeable] consequences of the act. <br /><br />Intentions speak to whether it's a sin.Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-18361128283202392872013-02-11T20:20:41.021-05:002013-02-11T20:20:41.021-05:00Effd, I wish I was as good sticking up for myself,...Effd, I wish I was as good sticking up for myself, as you are, here.<br /><br />You own what you feel is yours and you hold those responsible who are responsible for doing to you what they've done.<br /><br />I wish there were doctors who would support you in what you need. Mine did not support me either, gp deferred to psychiatrist and she would not get back to me, so I was left w/choice of continuing to harm kidneys/bladder, or get off mood stabilizer myself (which had BAD psych results the year before when I did that, but things were so bad physically that I had to do something). I don't recommend playing doctor, but for myself, I felt I had no other choice. We'll see if there's perm damage later this year at the urologist. My nladder/kidneys are now overreacting to other meds, including an anti-hypertensive my shrink prescribed that worked brilliantly for me combined w/vyvanse. Now she won't see me until after i've seen a urologist, and I can't get a physical to get a referral to one for two months, so it's gonne be 1/4 year or more before I get any more psych medical treatment.<br /><br />I hope you find the doctors to help you, again I reiterate I don't recommend playing doc one's self.Sarebearhttps://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-77200510916436006902013-02-11T12:45:41.846-05:002013-02-11T12:45:41.846-05:00Rob,
I don't need someone to hold my hand, tru...Rob,<br />I don't need someone to hold my hand, true. I would need my withdrawal to be monitored and I do not view that as hand holding. I don't feel the need to explain myself on that score other than to say I have medical conditions that probably mean I should not continue on what I take much longer and also that I am at risk of serious complications if I do not do it right. <br />Since no doc is gung ho on getting me off these drugs, it is in my hands and I should get off. That is my job and no one can do it for me. That said, I have been to doctors for infections that required antibiotics. I have never told a doctor which one to prescribe. I assume they know.If I were to have a serious reaction to an antibiotic,I would not blame the doc. I would not be happy but doctors cannot foresee every bad outcome. I do have a problem with the prescibers who started me on my current drugs. You could say I started myself since I swallowed the pills. I wasn't in much of a position at the time to doubt the wisdom of the doc with a wall full of diplomas while I was in the shape I was at the time. I didn't lie to the doctors to get drugs. I didn't ask for any drugs. Somewhere in the mess of it all, I was hospitalized for several months (might have been a good time to have been taken safely off the drugs) and I my doses were increased significantly. The nurses aides watched us swallow our meds. That is what happens when you are involuntary. Not swallowing your med is also a quick way to go from voluntary to involuntary status.I was there long enough that my body became used to the higher doses that I believe were prescribed to keep me docile and not because they would help me long term. At first, the dose increase kept me halfway comatose. By the time I got out, I could take it and not feel as though I had taken anything. So if I shovel blame, as you state, I think it is well deserved. We do not have a system set up to provide alternatives to people who are not well. I seem pretty well now since no one has a clue I am so dependent on drugs except my doc. I have read the Ashton manual. I have investigated treatment programs. If I ever go nuts again, I will be provided with a room in a hospital somewhere. If I want help getting off the drugs, I am on my own and, like I said, it isn't as easy as you make it seem. It is not about quitting smoking . That is damned hard and I have done it without anyone holding my hand but I was not at risk of anything in quitting smoking. Go judge someone you actually know. I did not come here looking for help. I came because I wanted to say that I know how easy it is to get drugs whether you are looking for them or not.Effdnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-16687538802045356902013-02-11T10:07:37.982-05:002013-02-11T10:07:37.982-05:00effd:
I did not say that kicking a substance is e...effd:<br /><br />I did not say that kicking a substance is easy. Here is what I said:<br /><br />"It is paternalism of the most crass sort to suggest that one needs help from credentialed professionals to wean off a substance that is harming you. Sigmund Freud had no trouble getting off opium on his own. Thousands (millions?) quit smoking without checking into rehab."<br /><br />It isn't easy, but it's possible, and you don't need a credentialed professional holding your hand (and collecting fees) to do it.<br /><br />Your situation is abysmal, even catastrophic. I would not wish your predicament on anyone. I only wish you owned a bit more of this, rather than shoveling all the blame on to prescribers.roblindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-40404926505069158062013-02-11T08:30:48.281-05:002013-02-11T08:30:48.281-05:00The guy's dead. He does not exist. What could ...The guy's dead. He does not exist. What could be unethical about publishing the medical records of a nonexistent person?<br /><br />Dinah, you're ignoring AA's initial point that the parents had been ignored when they'd done things the "right" way, the way you'd have been comfortable with. They couldn't get attention until they did something that made you uncomfortable. <br /><br />You're making this about you. It's not about you, it's about the difficulty of being heard. If I'm trying to save someone's life and you, an MD, are ignoring me, I don't want to get into a discussion of whether shouting at you to get your attention is not nice. I want you to save the person's life.<br /><br />*** *** ***<br />When linking to my beloved's obituary of his mother, I led with this statement:<br /><br />"In the british tradition one must not speak ill of the dead. One line of thinking is fear that the dead may come back to defend their honour. Another is respect for those not present to defend themselves.<br /><br />"In other traditions one must take care to speak the truth of the dead, to satisfy them that they have been well-understood and that they have left their own mark.<br /><br />"Mark has been conscientious in his account."<br /><br />http://www.alisoncummins.com/2007/12/12/necrology/Alison Cumminshttps://www.blogger.com/profile/06370841996857073237noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-31852743043511175832013-02-09T20:20:25.414-05:002013-02-09T20:20:25.414-05:00It's been 6 years. I'm sure Keith forgave ...It's been 6 years. I'm sure Keith forgave you for the quote.swimmakernoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-91390585228234030522013-02-09T19:41:53.032-05:002013-02-09T19:41:53.032-05:00Please don't speak for Dinah. Patient confide...Please don't speak for Dinah. Patient confidentiality extends to all medical treatment, as a legality, and not just psychiatric records. The question of whether it's okay to publish your dead relative's psychiatric records has nothing to do with whether I think the care given was appropriate or whether someone who prescribes medication has some responsibility for the outcome. <br /><br />I still like Jesse's answer. I think the motive of the person releasing the records to the press is important. <br /><br />There are many factors here, most of which we really don't know. The press sensationalizes. I was quoted in the NY Times once, I talked for 20 minutes to a reporter, she quoted one sentence fragment taken completely out of context to say the exact opposite of what I meant, and I called the subject of the article to explain/apologize.<br /><br />In general, parents of children with drug addictions have a very hard time, they feel guilty, they feel angry at the child, and in this case, they may well feel angry at the doctor maintaining the addiction (I would). They often feel helpless and their pain is tangible. They also grieve the loss of their child's potential and live through the awful consequences of the behaviors that addictions induce. <br /><br />If that's not enough, the parents of a child who has died of suicide bear a horrible load. They, too, feel angry, guilty, helpless, sad, and sometimes a bit relieved --either that their ordeal is over, or that their child is no longer suffering. <br /><br />I imagine the decision to tell a relative's story to a reporter is a complex one, and not one that boils down to a single bullet point.<br /><br />I don't know that this was the wrong decision, or even one that the story is one the son wouldn't want told. I just wanted to think about it and hear other peoples' thoughts on the issue. Thank you to all who contributed.<br /><br /> I do hope the story helps people and makes doctors aware that they medicines need more monitoring and family input (and lower doses!), that they shouldn't be used to enhance performance, and that patients who request them become more aware that there is risk.Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-35763655446631091132013-02-09T17:20:26.730-05:002013-02-09T17:20:26.730-05:00Thought it was an excellent comparison to another ...Thought it was an excellent comparison to another illness - if the topic was about diabetes or heart disease or cancer people like Dinah would be heralding the author. Only in psychiatry is there this sick and twisted lack of treater responsibility. Claiming it in the name of "confidentiality" and "ethics" is one of the more bizarre methods I've seen....but doesn't shock me that Dinah holds sway with it. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76698572720965813682013-02-09T12:22:01.095-05:002013-02-09T12:22:01.095-05:00Last Anon, Thank you. I am aware of the sites but ...Last Anon, Thank you. I am aware of the sites but I can't get a doc to prescribe according to those recommendations. I am on massive amounts of the stuff and it will a very long time to get off. My big concern is about not having any medical monitoring during the process. In a sick kind of way I almost wish I had an oxy addiction because there are lots of treaters here for that and I could go to a methadone clinic and get off the oxy. The benzos truly do nothing to help me with my anxiety after so many years. It is like i am immune to the anxiety relieving qualities they once held but am not immune to the effects of getting off them. I think the answer is to go into hospital to get off them but that would cost more money than I have. Insurance doesn't cover me for that. I will figure it out one day. What I wanted to get across is that the docs did not record the evolution of this. I wish they had. I am very cynical about what docs record or do not record. I am very cynical about a profession that prescribes a quick fix when it doesn't exist in real life. I think the Fees did the right thing in going public. They did not want their son to die in vain. It is not about whether his memory was honored or not honored by exposing his personal life and physicians have some explaining to do about their role in the creation of drug dependence and drug promotion and ignoring the part about first do no harm.Effdnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23640906481623144962013-02-09T04:44:36.967-05:002013-02-09T04:44:36.967-05:00Apologies for this off topic post but I wanted to ...Apologies for this off topic post but I wanted to respond to Effd whose story is heartbreaking.<br /><br />You might want to take a look at this list of doctors on the Surviving Antidepressants website who help patients get off of ADs. Perhaps if one is in your area, they could help with getting you off the Benzos.<br /><br />There is a link to doctors that allegedly help with benzo withdrawal but the concern is the list hasn't been updated for some time. Still, it is worth a shot.<br /><br />http://tinyurl.com/7cp8l8v<br /><br />The website is not beholden to any commercial interest and is dependent on donations such as an FYI.<br /><br />And I assume you have tried the Benzo withdrawal sites?<br /><br />Thanks Shrink Rappers for letting me post this. I hate to see someone suffering and wanted to provide information that might be helpful.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-2962435140873411402013-02-08T19:52:26.431-05:002013-02-08T19:52:26.431-05:00My doc puts very little in the record for the reas...My doc puts very little in the record for the reasons cited by Jesse. It isn't for my benefit only. Said doc does not want to ever be called to testify based on what was written. Don't write it and you won't be called. I had my record transferred to a new doc and was shocked to learn that med records were not accuratetly documented. My insurance can tell me when I filled a prescription. The doc did not always document the prescription. Not surprised. Started to see the doc for ^^^^anxiety. Got prescribed a drug that made me crazy. Then got placed on short acting benzodiazepines and then on short plus long acting to deal with rebound anxiety. Then got put on AP to deal with insomnia and anxiety that benzodiazepines could not cover. Had no idea I was benzo tolerant by that time. Gained 40 lbs in no time. Benzo was not discontinued. Trouble with mood then attributed by doc to the benzodiazepines but no dic wanted to help me get off the high doses I am on. So I take multiple drugs and not one of them was worth the price I pay. The docs worry only about whether the patient offs themselves today or tommorow. They dont care about long term chrOnoc side effects and dependency. Ya Rob, I could get off the stuff but not like Freud did. I risk seizures and more. Doc does not want to admit me to program to detox because doc would have to put the genesis of my physical dependence out there. It's not as easy as rob makes it sound and it's more serious than Dinah might want to think. Sure, as an adult I should be responsible. But I never asked for a prescription. I had no idea where it would end up. I wasn't given the info I needed. Meds were offered up as the natural and only logical solution. Did I want relief. Oh yes. Do I have relief? Not at all. If I die as a result of this and I don't doubt it, I want people to know what can happen when you seek psych care. Effdnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76007908676977346392013-02-08T18:34:29.745-05:002013-02-08T18:34:29.745-05:00One other comment regarding the confidentiality of...One other comment regarding the confidentiality of records: there are a number of ways that records leave a psychiatrist's office and can put a patient at risk. They could be caught up in a lawsuit about another medical issue, they could be caught in a custody battle, a patient could be pressured to release them for insurance reasons. I think, therefore, that a psychiatrist needs to be very cautious about recording non-medical information that might embarrass or seriously hurt his patient if it became known. jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-48125012133787629932013-02-08T16:19:54.914-05:002013-02-08T16:19:54.914-05:00Dr. Lynn,
Someone told me a story about a psychia...Dr. Lynn,<br /><br />Someone told me a story about a psychiatrist suggesting an SSRI because the person was depressed about a medical condition that anyone would be who was in a similar situation.<br /><br />When is this madness going to end? This isn't an isolated situation as this happens constantly.<br /><br />Please do what Robb suggests and take the power back instead of acting like you can't do anything about the situation. People's lives depend on it.<br /><br />AAAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-30863421965224040262013-02-08T16:12:42.895-05:002013-02-08T16:12:42.895-05:00Stigma. Stigma. Stigma. If someone disclosed,ad, ...Stigma. Stigma. Stigma. If someone disclosed,ad, or published ,ad,that you had gout or diabetes or a heart condition would the idea of that bother you now? Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-41534733057980347852013-02-08T11:44:30.619-05:002013-02-08T11:44:30.619-05:00Dr. Lynn,
For the love of God, if the 15 minute m...Dr. Lynn,<br /><br />For the love of God, if the 15 minute med check is such a travesty, don't do med checks!!! Spend time with your clients and learn their stories.<br /><br />And please (on my knees)do not lie to your clients about what these meds do. Amine CNS stimulants are performance-enhancing agents. They do not correct any chemical imbalance. <br /><br />roblindemanhttp://natickpediatrics.netnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-63873989743942530302013-02-08T11:00:36.972-05:002013-02-08T11:00:36.972-05:00I'm a psychiatrist, and I believe the most sal...I'm a psychiatrist, and I believe the most salient point of this case is how carving our profession out to only do "med checks" leads to poor, and occasionally tragic, treatment. Until we take on treatment of the whole person, we will have short med visits that allow us to make the most superficial medical assessments. This is a travesty.drlynnnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-28786176350608992042013-02-08T08:22:42.052-05:002013-02-08T08:22:42.052-05:00Anne Frank would probably have been just fine with...Anne Frank would probably have been just fine with having her diary published.<br />http://www.nytimes.com/1995/03/05/books/the-whole-anne-frank.html?pagewanted=all&src=pm<br /><br />She was getting it ready for publication. Her father removed the very personal passages prior to initial publication. By the time the definitive version including those passages was published, had she left the Annex alive,, she would have been in her late 50s. Would she really have had an issue publishing her adolescent thoughts about sexuality by the time she was in her 50s? smithnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47286841579595182682013-02-07T23:37:31.665-05:002013-02-07T23:37:31.665-05:00I like Jesse's answer.
Whether Anne Frank wou...I like Jesse's answer.<br /><br />Whether Anne Frank would have wanted her diary published really did make me pause, great analogy. <br /><br />I imagine the parents had complicated feelings, it comes with the turf of having a child with an addiction. It is a heart-breaking story.<br /><br />Dinahhttps://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-51667665404145988302013-02-07T23:08:30.546-05:002013-02-07T23:08:30.546-05:00@Tigermom, it does not die as far as the psychiatr...@Tigermom, it does not die as far as the psychiatrist is concerned. We still maintain confidentiality. But if the patient dies the right to the record and to the patient's confidentiality passes to his heirs. They can do as they wish, which can include suing the psychiatrist or otherwise making the record public.jessehttps://www.blogger.com/profile/11077223398907532291noreply@blogger.com