tag:blogger.com,1999:blog-26666124.post8918165558899945273..comments2024-03-18T03:28:36.581-04:00Comments on Shrink Rap: Can I Have a Word With You?Unknownnoreply@blogger.comBlogger11125tag:blogger.com,1999:blog-26666124.post-10243005263391141622008-12-06T22:43:00.000-05:002008-12-06T22:43:00.000-05:00In my setting (correctional), I try to imagine mys...In my setting (correctional), I try to imagine myself defending the note I'm writing a year from now in a courtroom. With this in mind, my personal preference is using "denied", which leaves no room to question whether or not I inquired about the symptom. That being said, different strokes, and all that. ;-)Dr. Pink Freudhttps://www.blogger.com/profile/12090769288313695919noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-46329901614176043612008-12-06T22:32:00.000-05:002008-12-06T22:32:00.000-05:00I am merely an English teacher, but he is correct ...I am merely an English teacher, but he is correct in the active vs passive process and what each one implies.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-7718193808193445722008-12-06T22:23:00.000-05:002008-12-06T22:23:00.000-05:00I disagree. If I state "reports no hallucinations...I disagree. If I state "reports no hallucinations", it means I asked and the pt reported that there were none -- <I>to report</I> is an active process. <BR/><BR/>However, "no reported hallucinations" means that the pt did not spontaneously report them, but I probably did not specifically ask -- a passive process. Seems like a subtle point, but to me it is very clear. Am I the only one to split this hair?Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-57349930393258774132008-12-05T17:00:00.000-05:002008-12-05T17:00:00.000-05:00"reports no hallucinations" implies the clinician ..."reports no hallucinations" implies the clinician never probed for the presence of the symptom.Dr. Pink Freudhttps://www.blogger.com/profile/12090769288313695919noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-34672919333038229162008-12-05T09:56:00.000-05:002008-12-05T09:56:00.000-05:00What about "reports no hallucinations?"What about "reports no hallucinations?"Family Nutritionisthttps://www.blogger.com/profile/00895139842355255623noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33115578100139944262008-12-01T17:37:00.000-05:002008-12-01T17:37:00.000-05:00In Spanish, the verb negar is used, lit. "to negat...In Spanish, the verb <I>negar</I> is used, lit. "to negate[/deny]" so all one is really reporting is that the patient answered "in the negative" to a direct question about such-and-such. I simply think it's a semantic nuance which when viewed from a broader scope becomes less contentious. <BR/><BR/>That said, I know psychiatry has (necessarily) its own unique paradigm and POV on many topics, and I've nothing to say or add to that. ;)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-76723287893972623452008-11-27T13:56:00.000-05:002008-11-27T13:56:00.000-05:00When writing up an H&P, there are three places...When writing up an H&P, there are three places where the presence or absence of hallucinations should be indicated.<BR/><BR/>1-<B>History.</B> This is the Subjective part...it's what the pt tells you. <BR/>Q: Have you had any hallucinations? Seeing things that aren't there? Hearing voices? Your mind playing tricks on you? A: No. You write: "Pt denies hallucinations." Not "No hallucinations", which would be a statement of fact, of certainty.<BR/><BR/>2-<B>Mental status exam.</B> This is the Objective part...it's what you as a clinician observe about the patient at that moment in time. Here, I would write either "No evidence of hallucinations," or something like "Pt observed holding what appears to be a 2-way conversation, but there is no one else there," or "Pt seen to pick at the air, apparently grabbing things that are not there."<BR/><BR/>3-<B>Assessment.</B> This is your conclusion. You conclude they do or do not have hallucinations, and characterize them, or you indicate you cannot conclude one way or the other.<BR/><BR/>And I often tell people "Just because you have hallucinations doesn't mean you're crazy."Royhttps://www.blogger.com/profile/08735111026336537653noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-62206590241996126832008-11-27T11:13:00.000-05:002008-11-27T11:13:00.000-05:00I remember that as a med student I was really amaz...I remember that as a med student I was really amazed at how many people hear voices too - in the context like you said, someone calling them for a minute or something. At first I sort of shifted into "admission gear" when I heard it and then learned that quite a bit of that is considered normal, that there's a big difference between psychosis and just hearing some voices. And I was really surprised, again, at how common it was, especially in some cultures or in places where history of drug use during sometime in life is common.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-66016107112687960322008-11-27T10:22:00.000-05:002008-11-27T10:22:00.000-05:00I like the word "denies" for many reasons. Often,...I like the word "denies" for many reasons. Often, I may have a paranoid patient, who I believe is minimizing symptoms, or simply denying them, when I see some evidence that the symptoms may, in fact be there. For example, if a patient denies experiencing auditory hallucinations, but is clearly speaking to someone that is not there, or is looking around the room, as if someone is there (who isn't), or something is happening (that I can't see), "denies' is a helpful word. It doesn't state unequivocally that the patient is experiencing the symptoms, but leaves room for the clinician's observations, and opinions.Dr. Pink Freudhttps://www.blogger.com/profile/12090769288313695919noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88469797948186670752008-11-27T06:12:00.000-05:002008-11-27T06:12:00.000-05:00"In describing patient symptoms, doctors also will...<I>"In describing patient symptoms, doctors also will sometimes use the statement "patient denies" symptoms. It's sometimes felt that this implies the physician doesn't believe the patient-- patient denies hallucinations is a different statement than no hallucinations."</I><BR/><BR/>When you say, "It is sometimes felt . . .", who feels it? The patient or other doctors? Also, do you mean that it *is* a different statement or that it can be construed as a different statement when it is not really? Does it just depend on the doctor whether he or she writes no hallucinations vs. denies hallucinations? <BR/><BR/>I know I am being nitpicky, but it is because I am curious.Catherinehttps://www.blogger.com/profile/18012100875719616898noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-19224998180350886882008-11-27T00:56:00.000-05:002008-11-27T00:56:00.000-05:00So, if I'm reading this correctly, it is not OK fo...So, if I'm reading this correctly, it is not OK for me to think that Obama delivered his victory speech specifically to me? Are you serious? Because I was moved to tears. We have a connection, that president elect and I. You just don't understand.Fat Doctorhttps://www.blogger.com/profile/09672076019531106668noreply@blogger.com