A psychiatrist looks within
Boston Globe
By Elissa Ely |
June 25, 2006
I LIKE TO write about patients, and have been waiting many years to
hear from those who believe this is wrong. I expected complaints about
self-serving motives and about violation of patient confidentiality. I
also expected complaints about rotten writing. Recently, all three
charges were made.
Accusations of rotten writing are hard to defend; writing is perfume,
each nose has its own opinions, and nobody smells good to everyone.
Self-betterment through the manipulation of innocent patients is a
little more inflammatory. I have certainly been bettered, personally
and professionally, by knowing patients and writing about them. But is
that taking advantage of them?
The most understandable charge is about patient confidentiality. We are
the rightful heirs of our own stories, even if not all of us can convey
them. And this is the era of the Health Insurance Portability and
Accountability Act, where releasing information without signed consent
is like a minor act of terrorism. I can't even ask my patients' medical
doctors for a list of the medications they have prescribed (which may
interact dangerously with the ones I prescribe) without faxing over a
release first.
I protect my patients technically; moustaches are added, accents
adjusted, genders changed so they tell their stories in camouflage.
Hopefully, it is hard to recognize the individual, but easy to
recognize the circumstance, feeling, or moment of poetry that made
their life worth reading about. Years ago in the state hospital, a
woman with terrible teeth xeroxed a piece of mine about a man with
terrible teeth and handed it out in Community Meeting. She insisted
everyone get a copy, whether they cared to read about her teeth or not.
Not much respect comes to the teeth of the chronically mentally ill. It
interests me that, in 20 years, I have not been accused by any patient
of misusing them for my own purposes.
The charge of violating confidentiality is especially ironic these
days. In my old hospital, a nurse practitioner had to run from the open
nursing station to her office two floors away just to finish a phone
conversation in which she had to say a patient's name. Speaking where
she could have been overheard was like spreading biohazardous waste,
punishable by fine or imprisonment.
Yet this is also the era of the National Security Agency and condoned
wire-tapping. Even supermarkets have come to know more than ever about
all of us, without our permission. We pass intimate facts along simply
through bits of daily living -- the eyes of cash register scanners,
magazine subscriptions, life insurance applications, charitable
contributions.
This information is not passed along to someone who loves us, or to our
caretakers. It flows through the hands of strangers into cybercoffers
that enrich their data banks. It goes on lists and makes its way back
to us in mailbox solicitations and phone calls from strangers who know
us on a first-name basis. It passes through a one-way mirror we cannot
see ourselves standing in front of. We are known involuntarily, by
strangers neither interested in nor moved by knowing us, and by people
who don't particularly care to make our lives better.
Maybe writing about patients in a public forum is terrible. Maybe men
in suits are lining up in the corridors of my old hospitals and
clinics, handing out cards with liability hot line numbers on them. But
it seems to me this is the wrong direction for righteous wrath. In
these times of sick war, sicker environments, and even sicker
decision-makers, there must be more important causes for moral outrage.
Still, since the charges have been leveled, I am worried, which is for
the best. I saw a patient last week; he likes to come early and leave
quickly. There is a lot about psychiatry he could resent -- his
medication side effects, for instance, or the lack of any prospect of
cure for his illness. But he always offers to help me carry heavy boxes
of charts down the hall before he goes. On this morning, he mentioned
that one of my pieces had been used in a discussion group in his Day
Program. He added politely that he had enjoyed it. I was thinking about
the charge of manipulating patient stories for my own purposes, and the
charge of violating confidentiality. (I have bowed to the charge of
rotten writing.)
``Obidiah," I said (this is not his actual name). ``How would you feel
if I wrote about you?"
``That's fine," he said. Some piece by some psychiatrist was the least
of his concerns. But he is well-trained in the routines of the world
these days.
``You want me to sign something?" he added.