Yet Another Reason Justifying My Complete Lack Of Trust

[just me here]

Thanks for keeping me grounded everyone. It is as I suspected, my T is required to cut and paste EVERYTHING into my health record where all can see it. BUT, she has been editing it down to an acceptable level of anger or cursing or whatever it was I was guilty of at the time, and even then only moving the stuff that was directly related to my diagnosis or when I asked her to forward info to other docs.

The rule came after I was using the email to talk to her, so she didn't apply it to my situation, or tell me about the new rule.

All is Okay, I am still in a trustworthy caregivers office and will be there for the foreseeable future.

A story about trust as it applies to Dr./ Patient confidentiality:

I was diagnosed with Hepatitis C and beat it in 2005.

My job required me to work with razor sharp tools all the time, I was constantly exposed to sharps, I was constantly in danger of getting cut and contaminating very expensive cutting tools. And I was looking at a treatment that could limit my ability to work for up to a year.

The first place I went was to my companies Human Resources department and I told the head of the department all I knew about my situation. I thought they should know, it was the right thing to do.

Our HR head was on the board of directors of our local hospital, so after talking to me he called the hospital to get more information. He was put in touch with a Dr. that explained the risks, methods of transfer etc. Our HR head evidently asked some pretty specific questions, and after their discusion the Dr. evidently knew that there was a Hep C case at my company and he knew what department it was in.

He talked about it with a nurse whose husband worked there, warning her to tell her husband to be careful at work.

He and his wife were both good friends of mine. We had fished together, eaten dinner at each others homes, gone camping on our vacations together. When he got home that night, she told him about the Hep C case, and what department it was in. The next day, less than 24 hours after I had talked to human resources, my friend stood in front of me and warned me that there was Hep C about, and it was in my department.

I could have destroyed the careers of several people, one of wich would definitely have been my friends wife. Another might have been my friend, and another might have been mine, although I probably would have been moved to a job picked to make me quit on my own rather than be fired. They aint smart, but they are far from stupid in HR.

So, that experience and others like it make me very protective about who I tell anything about my health, and to even think for the past 48 hours that I might be seeing my personal info getting into the hands of nurses and clerks was enough to trigger me to a repeat of the anger and stress of the previous experiences.

My emails to my T included my thoughts of suicide, the depth of my disgust with the prescription trail I have been on for sooo long, my difficulty in maintaining the diets and restrictions I face due to my liver and medications.

This isn't stuff I want sitting on the desk of someone someday that is trying to decide if I get a liver transplant or not. I have always been led to beleive that the only thing on my general record from the mental health department would be diagnosis and prognosis of disorders, nothing more. Now I know that ANY communications are supposed to be put in, and that some of mine have been, but I feel I can trust my T to have only put in very little, non harmful stuff.

Today I thanked her for her discretion, warned her that I am not worth risking her career over, and offered to stop sending her anything via email, official or not.

Thanks for the support, thanks for caring enough to post, thanks for helping me through this. This forum has been the best part of my PTSD diagnosis by far. Thanks.

Picture me sitting by a stoked woodstove watching the snow fall and feeling cared about by some really wonderful people on the PTSD forum. Thats my plan for tonite, thanks again.

 

[anthony]

I just got blindsided by a trusted therapist, I just found out that all emails sent back and forth between us are cut and pasted into my permanent medical record.

There is a legal and ethical requirement for this to occur... reasons are:

• If you leave, accurate records must be attained for transfer of all communication.
• If you attempt to sue, the therapist must keep accurate records for which they can then present as evidence.
• If you need information from past discussions, they can provide it for you, which they must legally.
• You are not your therapists only client, so they often will need to recite previous conversations to jog their memory.
• They use your past information to also provide a snapshot of whether current techniques are effective or not, ie. gauge before and present writings, conversations, symptom severity scales, etc.

Its really not about sharing things... its a legal and ethical responsibility they have, regardless what you perceived your relationship with them to be, they must maintain a professional relationship, which means legal documentation requirements. I very much doubt the therapist is going to do anything that would breach their legal responsibility for confidentiality... so I don't believe you should be too worried.

 

[anthony]

Added: Just reading your last response, it seems you discovered these things for yourself through your therapist.

 

[anthony]

Moved to therapy forum, as this is about therapy, not about symptoms or another disorder.

 

[No Folded Hands]

Hmmm. Let me put in a few words. Happy that your situation has resolved, btw. :) appaled to hear about the previous HR/MD thing. :(

A few years ago I was the person who headed the department within the hospital that handled the situation when anyone had a needle stick. That is, we didn't do the testing for various blood borne diseases, but we handled paperwork and tracking and educating. So, when the (married) member of housekeeping who'd gotten stuck emptying the trash was sent to us demanding to know who the needle had been used on (and preferentially that he or she be tested for HIV among other things) it was bumped into my hands. As it should have been, that sort of hot potato's the job of the guy in charge, not the people working under him or her. After looking into the situation I had another meeting with the housekeeper. And of course, I couldn't give out the information both spouses wanted.

Did I know who had tossed the needle into the wrong bin? No, but we'd narrowed it down to two possibles.

Did I know whose blood was contaminating the needle? Yes.

Did I know the HIV status of that person? No. But I had information that made the chances pretty small. Which, of course, I also could not reveal, because it might have led them to who the person was.

What did I do? Well, one, the department in which the stick had happened reviewed proceedures with everyone. There hadn't been such an incident for a considerable period of time, but everyone gets rusty. Continuing education was stepped up for the future, too. Then, two, as I knew by then that the housekeeper was afraid not only of contracting a fatal disease but of passing it to spouse and kids, I instituted full needlestick protocol even though it was supposed to occur only for those involved in direct patient care. (IE the housekeeper was repeatedly tested at specific intervals for a full year.) Last, we sat down and talked extremely candidly. About the very small chances that there was an infection in the blood in that needle and the fact that I absolutely could not give any specific info about identity or require that person to get tested. And about precisely how to be as safe as possible in regards to potentially passing anything to the family, including the relative safety of various sexual practices.

I made the decisions to handle it that way, but I am far from the only one in like position who would have picked similar courses of action. It was really tough withholding that info from those two under the circumstances, but it would have been horrifically unethical not to. Legalities be d*mned as not important here. I had to KNOW the information to as efrectively as possible handle the situation, but I could not GIVE out the information. I also could not just say so and leave it at that; that too is unethical. It is as simple as that.

As someone who has been on the other side of it, I wish for you that you never again run into someone who does not stand up when such a tough choice falls to them, and do the right thing. I wish that for us all. :)