Monday, July 16, 2007

Let Me Tell You About My Patient

There's a story I've been wanting to tell you. I've been waiting, trying to give it some distance from the real-life tale, figuring I'd get to it. I've been writing it in my head, thinking of ways to manipulate the story to get it to reflect my emotions and my experience while disguising the real story.

I always feel a bit ill at ease when I write about my experiences with patients, and with this, our 502nd Shrink Rap post, I've only written about "real life" tales a couple of times. I wrote once about a patient who was a criminal, and trust me, my patient would not have recognized himself (at least not by description), all that rang true from that post was the following: I have a patient in some illegal means of obtaining money and knowing this makes me uncomfortable. I could have just written that sentence, purged myself of the feeling for the day, but the story you'd like to read is in the character, real or fictionalized, who gets us to that point. I've wanted to write a post about Resilience and to say, without a vignette, that some people are pretty resilient-- well, it's pretty hollow. I'll point out that my pseudonymous co-bloggers ClinkShrink and Roy pretty much never talk about patient encounters, except when Clink quotes her patients as saying she walks like a psychiatrist (she does).

So why the fuss? I've been thinking about my post for a little bit, feeling ill at ease with the patient part of it-- yes, the patient will be fictionalized but my response to the tale is not: if this particular patient read the very-confabulated story on the blog, he might say, "Hey, you said that to me!" Is that wrong? A lot would be assumed here: 1) That someone actually listens to what I say and 2) That I don't say the same things to lots of patients ...umm, actually I reuse lines a lot-- the human condition bears lots of similarities amongst it's members and if I can find something to say that resonates or offers comfort, you bet I'm recycling it, and 3) That it would trouble a patient if I talked about what amounts to my "Isn't that interesting?" feeling about someone's session or condition.

And so as I was about to post about Resilience, I came upon Ad Libitum's post on blogging about patients: It violates confidentiality, it can erode trust, the physician becomes distracted by his never-ending search for bloggable stories, the patient really owns the story and when the blog gets turned into a book/movie, the patient does not share in the royalties (huh? If only...). Ad Libitum says we should obtain consent from the patient, make the patient unrecognizable or an amalgam, and best of all we should not blog about patients. There are a lot of rules here, and these folks are blogging anonymously.

Then came Grunt Doc who calls Ad Libitum "a professional scold." It's okay, he says, to blog about patients who are sufficiently disguised, stories are shared, and so little of our lives are blog worthy that we won't be distracted anyway.

So how come it's okay for patients to blog about their psychiatrists, without disguise, without permission, without hesitation?

Interesting stuff to think about. I think I'll hold off on that Resilience tale for yet another day.


NeoNurseChic said...


I don't give my psychiatrist's name. I think the closest I ever came was putting his initials - and saying that he'd had an article published in a certain journal on a certain topic. If someone really wanted to, they could then figure out who he was. But I doubt most would go to the trouble! Or maybe I'm wrong - I say lots of good things about my psychiatrist! :)

I was going to write more, but then I deleted it. Have to think on this before I add the rest!! :)

I like stories about resilience... I haven't survived anything that is gigantically awful in all reality, but I do consider myself to be resilient for the circumstances that I have faced. And reading about other people's resilience makes me feel inspired. Only sometimes does it make me feel like a horrible whiner/complainer/who should stand a lot better on my own when I hear how bad OTHER people have it. (ie. The time when I was upset about my limp and very bad knee pain/bone condition when I passed a guy walking with help on 2 prosthetic legs...I felt like a real jerk...)

But mostly, I find stories about resilience to be inspiring and helpful. :) I love watching the Iron Man every year - makes me feel energetic and hopeful!

Did that all come out wrong? Ah well - I'm home late last night from Ohio - after being in Stone Harbor all week =and then going to Ohio from Friday to Sunday, and on the whole spent way too much time in a car and then had to go to work today! Brain is shutting down... ;)

Take care!
Carrie :)

Roy said...

Just do what I do... make it all up.

NeoNurseChic said...

Roy - you don't write about patient interactions really at all, though... I learned myself that it was very hard to make up stuff related to my job because the real stories were so much better than anything I could ever dream up. So the blog that I had started intending to be a commentary on neonatal nursing became a blog about my life with very little on neonatal nursing at all!

Rach said...

Dinah, always interesting thoughts. Yes, you don't use the patient's name, you don't use the patient's real story, 99.8% of what you'll write is confabulated. Aren't most fables the same - the idea being that they have a moral lesson at the end?

I also don't use my shrink's name in my blog (i've taken to caling him nitwit or dingbat... I'm sure you can tell how I feel about him). It's not a matter of privacy or protection, there's simply some things I prefer not to shout from the rooftops. But as Carrie so eloquently puts, If someone really wanted to, they could figure out who he was.

I think I enjoy reading about your random pursuits, movie reviews, conversations with the judge (whom you haven't mentioned in awhile) and other random (kinda related) psychiatry topics rather than just your patients... but tell the stories - I'll read 'em!

P.S. check out my blog - i wrote a story about buying a hoodie while in the throws of a manic episode.

Sarebear said...

Hey Roy, have you seen

It's a non-Itunes way to access podcasts. Since I neither have an ipod (mine is samsung, which would work fine but), and I don't want to install Itunes' software, that doesn't really leave me anywhere I can SUBSCRIBE to podcasts, which drives me nuts. I guess that's ok since you three are shrinks ;^P

I want the same convenience other people get, dangit! Today I found, and I don't mind putting their software on my Samsung. I did a search on "shrink", as no mental health ones came up under alternative, self-help, or the regular "health" category for podcasts over there. I found two, but not yours.

Could you pretty please, with a duckie on top, see about maybe getting in over there? Thanks for thinkin' about it.

Sorry Dinah, I had to chat with your techie person (Clink is too, but Roy usually does this sort of stuff.)

Dinah, sounds thorny. And I'm uneasy about the very few times I've named my providers, even somewhat about 'ole Dr. Dorkface, er, my first psychiatrist. It isn't that we disagreed on some things that leads me to that; I respect his having a different opinion; it's his unprofessional conduct and demeaning, insulting, derogatory, degrading treatment of me that I take strong exception to. Even for him, though, I'm uneasy about when I've mentioned him by name. I admit, after he closed private practice, I mentioned his name out of hurt and revenge, hoping anyone googling him would find it.

That's nasty of me, isn't it? (There goes labeling, again . . . . .)

Anyway, I hope you guys don't think less of me, but I figured I may as well be brutally honest about my shortcoming(s) there, since you wondered why patients get to post whatever they want. It is something I've thought about, have some guilt over, and still haven't figured out where to land on it, although I s'pose I may eventually pull the names (too late in many respects, Google caches things, but . . . .)

I do NOT think that being a doctor should make one have less rights to talk about their life with others in the way that other people do; obviously accommodation for the fact of the patient/doc relationship and privacy rules, etc., but I've felt, for quite awhile now, that I hope it gets decided in a high court sometime, in FAVOR of the medical professional, that as long as things are obscured to a point that any reasonable person or any reasonable medical professional peers would agree was quite obscuring, and that these types of reasonable people would agree that it seemed no one but the patient would recognize anything, and only what you had to say anyway, that with those simple ideals in mind, you are free to participate in debate and discussion and posting and talking about a major aspect of your life with people, like other people get to.

I know I took alot of words there to describe it, but I think the premise is a fairly simple, and a very reasonable one.

Psychiatrists are people too. All doctors are, and in alot of the media "hysteria" or "feeding frenzy" about docs that might say too much, I think that that is forgotten, and people want them to be these perfect icons up on pedestels; they forget that docs are people too, with feelings, and experiences that they'd like to share and stuff.

Anyway, off my little soapbox.

(p.s., when do I get my bribe? You said you'd send chocolate! ;^D)

Anonymous said...

Bloggers ranting about their shrinks would do better to either find another one if they really hate them as much as they say or, in cases of actual abusive treatment, violation of boudaries, etc , they should file a complaint and be ready to back it up. All should steer clear of "providers" who are accountable to no one, do not belong to professional orgs that can be called upon to investigate.
Should patients be "allowed" to blog about their shrinks, and what is the dif btw that and a shrink blogging about a patient? No one should be out there making libelous comments, but why should there not be a forum for actual reviews, for lack of a better word? Actually, there is; or something like that. The site doesn't allow vile things to be said but it is a forum to complain that a doc doesn't do things that one would reasonable expect and also a place to compliment the great ones.
Why can't shrinks have a place to rate patients? WOW. When a person goes into therapy, one basic principle is confidentiality. We know that some shrinks break this at the kitchen table or other places but in a public forum?
Anyone can write a scathing restaurant review. Got food poisoning, service sucked... If you get paid to provide a service you should expect some type of response, good or bad. No one should say oh my shrink is a pedophile, unless that has been proven in court or unless the writer is 11 years old and the shrink has messed with him or her.
But really, look around and read a book like one of the ones crapping on god and you will see that if god is not immune then no one is.

Anonymous said...

Gorsh, I think I remember you writing that you were pretty sure that your patients do not read your blog.Veeerry interesting but ...S______.

Sarebear said...

First Anonymous, there's also a site called HealthGrades.

As for finding another one, I recently found out over the last 8-9 months exactly how hard that is. It may not be an option, actually.

Seriously, that's how I feel. That has been my experience; it depends on the situation, location, alot of stuff.

Anonymous said...

I will refer only to the ones who do "therapy" when i say that if there is so much wrong with them, then leave, get out, run, run, run. for your sanity. zero therapy is better than mind games and dealing with an incompetant "ist".If all you are going for are periodic med checks it is possible to stay with a doc you can't stand when it would not be possible to find is not preferable, merely possible.
don't know that we get the health grades site here. in any event, docs should get used to it and yeah,to whomever said it, dinah sounds really thorny.

Rach said...

Bloggers ranting about their shrinks would do better to either find another one if they really hate them as much as they say or, in cases of actual abusive treatment, violation of boudaries, etc , they should file a complaint and be ready to back it up. All should steer clear of "providers" who are accountable to no one, do not belong to professional orgs that can be called upon to investigate.

I could write a whole post of my own in response to this, but I'll merely outline the reasons why I continue to blog about how much I hate my shrink and still continue to see him:

- the 18 - 24 month wait list here in our socialized system for another shrink taking new patients is too long to wait
- he's a good diagnostician, yes - his other policies and the way he runs his practise leads much to be desired. I'd just do things differently.
- I take exception to certain practises that come with being a human being (this human being just happens to be my psychiatrist). I also happen to take similar exception with my mailman and the accountant in my office., But I don't go replacing them, do i?

Anonymous said...


obviously, you do not really hate the guy all that much, and neither is he doing you terrible damage. if he is doing you damage and you are good with that, whatever.
you seem to be saying that you find him to be irritating at times, and that is an entirely different kettle of fish than the abusive, deserving of hatred, shrink. if he merely pisses you off and you are willing to accept that as part of his being a human being like your mailman, and you think he is a good dx'er then that's great.
there are shrinks taking new patients, even in our socialized system.

Sarebear said...

I meant the PROBLEM was thorny, not that she sounded thorny; you are twisting my words.

Anonymous said...

Dinah, Thanks for your comments on my post. My post was mostly stimulated by the two articles I cited at the end of the post. They make interesting reading. Check them out if you have the time. The full text is available if you click on the links. Ad Libitum

Anonymous said...

As I reread your comment, you did use a comma which means that I did twist your words because that is initially what I thought you wrote.
I am sorry for twisting your words.

Rest of comment:
So that no one can twist my words: Dinah sounds thorny, to me. I also thank the heavens above that I have a shrink who can tell the dif btw patients talking or blogging about docs, and docs doing the same that about patients.
I never said that anyone should get away with libelous comments.
If you hate your mailman because he delivers unto you others' mail,you can complain to the post office. You can write about how much you hated the hotel you stayed in one night.Shrinks are used to working solo in many cases, and to not having their authority questioned. Some of them are dangerous, but isn't it handy when someone points out that patients are "mentally ill" so whatever they say is crap or made up.

Sarebear said...

Thanks, Anonymous. Understood.