Monday, July 16, 2007

Let Me Tell You About My Patient

There's a story I've been wanting to tell you. I've been waiting, trying to give it some distance from the real-life tale, figuring I'd get to it. I've been writing it in my head, thinking of ways to manipulate the story to get it to reflect my emotions and my experience while disguising the real story.

I always feel a bit ill at ease when I write about my experiences with patients, and with this, our 502nd Shrink Rap post, I've only written about "real life" tales a couple of times. I wrote once about a patient who was a criminal, and trust me, my patient would not have recognized himself (at least not by description), all that rang true from that post was the following: I have a patient in some illegal means of obtaining money and knowing this makes me uncomfortable. I could have just written that sentence, purged myself of the feeling for the day, but the story you'd like to read is in the character, real or fictionalized, who gets us to that point. I've wanted to write a post about Resilience and to say, without a vignette, that some people are pretty resilient-- well, it's pretty hollow. I'll point out that my pseudonymous co-bloggers ClinkShrink and Roy pretty much never talk about patient encounters, except when Clink quotes her patients as saying she walks like a psychiatrist (she does).

So why the fuss? I've been thinking about my post for a little bit, feeling ill at ease with the patient part of it-- yes, the patient will be fictionalized but my response to the tale is not: if this particular patient read the very-confabulated story on the blog, he might say, "Hey, you said that to me!" Is that wrong? A lot would be assumed here: 1) That someone actually listens to what I say and 2) That I don't say the same things to lots of patients ...umm, actually I reuse lines a lot-- the human condition bears lots of similarities amongst it's members and if I can find something to say that resonates or offers comfort, you bet I'm recycling it, and 3) That it would trouble a patient if I talked about what amounts to my "Isn't that interesting?" feeling about someone's session or condition.

And so as I was about to post about Resilience, I came upon Ad Libitum's post on blogging about patients: It violates confidentiality, it can erode trust, the physician becomes distracted by his never-ending search for bloggable stories, the patient really owns the story and when the blog gets turned into a book/movie, the patient does not share in the royalties (huh? If only...). Ad Libitum says we should obtain consent from the patient, make the patient unrecognizable or an amalgam, and best of all we should not blog about patients. There are a lot of rules here, and these folks are blogging anonymously.

Then came Grunt Doc who calls Ad Libitum "a professional scold." It's okay, he says, to blog about patients who are sufficiently disguised, stories are shared, and so little of our lives are blog worthy that we won't be distracted anyway.

So how come it's okay for patients to blog about their psychiatrists, without disguise, without permission, without hesitation?

Interesting stuff to think about. I think I'll hold off on that Resilience tale for yet another day.