Saturday, July 21, 2007

Let Me Make Myself Perfectly Clear

Over the last two weeks, ClinkShrink and I have written a series of posts about the flow of information between therapist and patient, and the flow of information between those parties and their blog readers! Let Me Tell You About Myself looks at the issue of therapists divulging to patients that they themselves have a mental illness. Let Me Tell You About My Patient went on to talk about confidentiality issues in therapy when the psychiatrist has a blog, and Let Me Tell You About My Doctor asks whether it's okay for a patient to write blog posts about their physicians. These posts received a lot of comments, discussion, and brought up a lot of feelings on the part of the both our readers and we three bloggers.

Let me tell you that while I love to stir things up a little, I've been surprised.

To be clear: I can only recall a few posts of our now 506 (yup) posts where I discussed a patient scenario-- the descriptions, the demographics and the issues at hand were all confabulated to the point of fiction and the patients were not recognizable, they are essentially literary Avatars. The posts were about me and my feelings. Of the few (maybe 2-3) posts where I've painted a scenario, the possibility arises that patient could visit the blog and say, "Hey, here's my doc, and I'm a criminal, and she wrote a post about being uncomfortable about treating someone who's a criminal (See: The Patient As Criminal) but I don't drive a Porsche, or wear a Rolex watch, or have 3 kids, or even own a blue suit." The "patient" might have some discomfort learning that I'm uncomfortable (hmmm, Tony seems to know Dr. Melfi was pretty ill at ease).

The truth is, I feel a twinge whenever I so much as mention the existence of a patient. A what if scenario.... so remember my post about my chaotic day where I told a patient (no details about patient at all) that I'd return her call but I then threw my cell phone, with her phone number, into my washing machine? I wondered, what if this patient told all her friends, "I called this ditzy shrink who lost my number in her submerged cell phone," and then her friends saw my post, they'd know who her doc was! Funny, but I don't worry about what if she runs into a friend in my waiting room, who then knows who her shrink is.

I guess the real issue here is one of discomfort, my own and yours, and the theoretical discomfort of any patients who stumble across this. Readers have made comments discussing how they wouldn't like their psychiatrists to have a blog, how they'd worry about their confidentiality, and how it might be uncomfortable to know their psychiatrist in the way that Clink, Roy, and I have let ourselves be known on Shrink Rap. Mine is a more intimate and playful voice than I use with patients. Clearly I might be a little uncomfortable sharing this world depending on my patient's response, and truly I hope I don't make my patients uneasy.

I think the bigger issue is one of Who we Hope our Docs will be outside the office and how much a professional is obligated to live their personal life to a set of fantasized standards-- we'd all like to think our physicians are upstanding, totally moral, law-abiding, healthy-living, paragons of practice-what-they-preach and the existence of a blog threatens that fantasy. It's just docs and shrinks, it's all the folks we see as taking care of us from our yoga instructor to our elected officials and many of us have feelings about what our presidents do with their cigars.

There is no issue at Shrink Rap about ethical violations, power struggles, damages, breach of trust, or lawsuits-- things that came up in our comment section. It's all about comfort and discomfort, I saw the issue as being smaller than the discussion grew it to. This is not to scold, it's just to express my surprise.

Finally, my thoughts about patients blogging about their docs. If the doc is written about in a derogatory way with any possible identifying information, then I think there are better ways of complaining about a doc. If you're writing about your sessions, if your blog post is therapy for your therapy (!), and your shrink is identifiable, I guess I think you should let that be known to the doc. I don't believe that because someone has a psychiatric disorder, anything they say is immedicately discounted. I just don't. Mostly, it's about human courtesy and mutual respect. We're still all just figuring out the rules here.

So Roy asked me not to stir everyone up. I hope this is okay.
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