Saturday, January 30, 2010

Is It Okay to Lie to Your Doctor?

It's snowy here in Maryland.

First, let me say that it's never okay to lie to your shrink. Therapy is about having an honest interaction, and a psychiatrist probably can't help someone who is hiding a secret life. This post, however, was inspired by Clink's last piece, Rage Against the Machine where she wails on Electronic Medical Records, in a feeble and failed attempt to engage Roy in a fist fight. There she is a punchin' and he's just skating along oblivious as can be.

Why do EMR's make me uneasy? When I'm in the clinic with patients and I can access their medical records, well, it makes life easier. So why don't I like the whole idea? I talked about some of this in the comment section on Clink's blog post.

With an EMR, it's easier to get records, and any doctor in an institution who treats a patient has access to them (oh, the whole institution has access to them, but only those involved in the patient's care are allowed to "peak"). What if a patient wants to withhold some of their information from certain docs? Is that lying? Is that reasonable? Should that be allowed?
If it's about obtaining prescriptions for controlled substances, it's just wrong. But might there be other reasons a patient would want to control the flow of information?

Let's face it, some docs and some patients don't click. A patient may feel the doctor didn't really listen, saw him much too briefly and jumped to a conclusion without hearing all the information, or was uneasy with the doctor's conclusion. The patient comes for treatment of his headaches, and after a few minutes, the doctor says it's "Stress." The patient wants more tests done, the doc feels it's unnecessary, and the patient would like to get a fresh opinion. Electronic Records may hamper the ability to get a fresh opinion. The next doctor may look at the note and agree with the patient that more testing should be done, or he may see another doc's opinion and go with that. And who knows what the first doc wrote, it may continue to prejudice future care. All sorts of human emotions get tossed in here: What if second doc hates/adores first doc, that may prejudice what side he takes. Any way you dice it, if the question is so much as raised that a patient is malingering or that an illness is factious, medical professionals may shut down.

So how does this pertain to psychiatry? Psychiatric patients are often given sub-par medical care. Their medical symptoms are more likely to be attributed to their psychiatric disorders (and sometimes this is appropriate after a reasonable and thorough work up). Perhaps a patient worries that if he tells a doc he's in therapy, his problems will not be considered as valid. I think this is getting better.

Roy would say that the patient should be involved in the evolution of the record. Maybe Roy should say what he wants to say....

And you didn't really think I was going to say if it's okay to lie to your doc!
So I'm adding this as a next-day addendum: Talesofacrazypsychmajor left us a comment saying that primary care doc who knew of psych diagnosis felt it had to go on every school form that needed to be filled out (presumably for school, work, camp) and perhaps that's a valid thing to reveal to any institution needing medical information. However, it is an example of how the patient is out of control of their information. This example is obviously not an EPR issue alone, but EPR's make the spread of information easier for better or for worse.