December 18th, 2011 by Dinah Miller, M.D. in Opinion, Research
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For a while now we’ve been talking about issues related to psychiatry and electronic medical records. Roy is very interested in the evolution of EHR’s.
I don’t like them. I think they have too many problems still, both in terms of issues of efficiency and time, and how they divert the physician’s attention away from the patient, and they focus medical appointments on the collection of data– data that is used in a checkbox form: patient is not suicidal and I asked, whether it was clinically relevant or not– and will therefore serve as protection in a lawsuit, or demographic information used by insurers, the government, who knows.
From a privacy standpoint, I think they are appalling. If you are a patient in the hospital where I work, you get Read more »
*This blog post was originally published at Shrink Rap*
December 13th, 2011 by Dinah Miller, M.D. in Opinion
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In yesterday’s post on e-prescribing, the issue of patient confidentiality came up in the context of doctors being able to see a patient’s full medication history in an electronic program, and one commenter brought up that she doesn’t necessarily want to tell her shrink about a yeast infection, perhaps because she finds it embarrassing. The writer of the post, a guest blogger, suggested that this might lead to useful information that should be addressed in therapy, for example the patient’s sexual life.
Years ago, I remember being a bit taken back when a patient brought up some rather problematic (to him) sexual issues in his marriage. It wasn’t the nature of the issues that surprised me (I spent more than a decade consulting to a sexual behaviors unit and I spent several months of residency training on an inpatient sexual disorders unit: it takes a lot to shock me). What surprised me was that this was the first I was hearing about this issue after seeing the patient for 5 years of psychotherapy. He had a secret life.
There’s not really much to do about this. One can only Read more »
*This blog post was originally published at Shrink Rap*
November 26th, 2011 by Dinah Miller, M.D. in Opinion
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I’ve been asked several ‘ethical dilemmas’ in the past few weeks. I’m putting them up on Shrink Rap, but please don’t get hung up on the details. These aren’t my patients, but the details of the stories are being distorted to disguise those involved. The question, in both cases, boils down to: Should the mental health professional report the patient to his professional board?
In the first case, a psychiatrist is treating a nurse who is behaving badly. The nurse is stealing controlled substances from the hospital and giving them to friends who ‘need’ them. She doesn’t intend to stop, and her contact with the psychiatrist was only for an appointment or two before she ended treatment. Should the psychiatrist contact the state’s nursing board? Is he even allowed to?
In the second case, Read more »
*This blog post was originally published at Shrink Rap*
November 20th, 2011 by Dinah Miller, M.D. in Opinion
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Psychotherapy is, by it’s nature, a narcissistic endeavor. That’s not to say that the patient is a narcissist, but the journey itself is meant to focus on patient’s interior life, and it’s not always about the greater good. In my last post, several commenters said they feel uncomfortable talking about themselves or worry that their therapist will mistakenly think they are narcissistic because they talk about themselves in therapy.
It’s not at all unusual for people to express some discomfort about talking about themselves in therapy, or to comment, “all I do in here is complain,” or “You must get tired of hearing people complain/talk about their problems, etc….”
I won’t talk for other psychotherapists because I only know how I feel. It seems to me that the mandate of therapy is for the patient to talk about the things they have been thinking about. The truth is that most people think about themselves, and issues of the world are interpreted by individuals as they impact them. Some people Read more »
*This blog post was originally published at Shrink Rap*
November 13th, 2011 by Dinah Miller, M.D. in Opinion
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We’ve been having a great discussion over on the post Tell Me…. An Ethical Dilemma. The post talks about a young man who wants to know if he can check “no” to a question about whether he has a psychiatric disorder if his illness is not relevant to the situation. The comments have been fascinating — do read them– and very thought-provoking.
One reader asked, ” If a patient asked if they were boring you, and they were, would you say yes?”
This is a great question, and of course the right thing to do is to explore with the patient what meaning the concern has to him. But is that all? I’m not very good at doing the old psychoanalyst thing of deflecting all questions, and mostly I do answer questions when they are asked of me. This can present a really sticky situation because one can not think of any clinical scenario in which it would be therapeutic to have a therapist tell a patient, ‘Yes, you’re boring, OMG are you boring,’ or ‘No, in fact, I don’t like you.’ And not answering could be viewed as negative response by the patient –if you liked me, you’d tell me, so clearly you don’t like me. So if the exploration of the question doesn’t take care of the issue, and the patient continues to ask, what’s a shrink to do? Read more »
*This blog post was originally published at Shrink Rap*
For a while now we’ve been talking about issues related to psychiatry and electronic medical records. Roy is very interested in the evolution of EHR’s.
