Posted by: Kate | September 2, 2008

Accurate Assessment

The interview with the patient was fairly straightforward.  He admitted that, yes, he drinks.  A lot, and often, and he’s starting to realize that he couldn’t stop on his own if he wanted to.  He acknowledged that he took an overdose of Valium while drinking, but insisted that he never would have tried to overdose if he was sober and it wasn’t really a suicide attempt.  “I don’t want to die,” he said, “I just didn’t want to wake up anytime soon.”  He refused to consider a stay in a psychiatric hospital because he didn’t want anyone to think he was crazy, and involuntary substance abuse treatment is not within my scope of authority, so I can encourage him to seek help but I can’t force it.  “I’ll think about it,” he said, “but I don’t really want to stop drinking.”

Not the smartest, healthiest approach to life, to be sure, but you’re allowed to be stupid and unhealthy in New Hampshire.

As I was leaving, he said, “Oh, by the way, my brother is in the waiting room.  He wants to talk to you before you leave.  It’s OK with me if you talk to him now, but I don’t want him to be able to read my chart or anything.”  I explained that, with his consent, I could talk to the brother at the hospital, but without written consent he would not be able to access his medical or mental health chart.

So it was that I went to speak to the brother.  I had a suspicion that it was going to be a somewhat less than productive conversation when he made me wait five minutes while he worked to proselytize to a fellow waiting-room occupant (and, apparently, a total stranger) and then admonished the woman for not being instantly devout.  I stepped in at this point and suggested that he come chat with me, thereby giving the woman a chance to politely escape, with a whispered “thank you” in my direction as she scurried for the door.

Most of the time, when I speak to families of patients, I choose to steer the conversation in the more general terms of the mental health system, hospitalization options, referrals, and so on.  He repeatedly asked for a verbatim account of my interview with his brother, which I repeatedly declined to provide.

It didn’t take long for him to slide from worried to self-righteous, and then from self-righteous to angry.  “What do you mean, you won’t tell me everything he said?  He’s my brother.  I have the right to know everything about him.”

“Well, actually, no, you don’t.  I’m bound by laws and ethics to protect his confidentiality.”

It went around for several minutes, and I’ll spare you the details because I know how very uncomfortable a concussion is.  I won’t risk you falling asleep and bonking your head on your keyboard.  Instead, I’ll skip to the end, where he proved, in two consecutive sentences, that he has deep and incisive assessment skills, himself.

“So, what you’re saying is, you think that my brother’s right to confidentiality is more important than my right to know everything about him?”


He sighed, glared, stood up and pointed rather aggressively at my forehead.  “You’re going to go to hell, you know.”



  1. To which I would have responded, “Yes, I know. But not for the reasons you think.”

    But I’m guessing you’re not allowed to say such things while on the job.

  2. Hahahahahahahahahaha. What a douchebag.

  3. You’re going to Hell? Me too, we’ll have fun! Good onya for sticking to your guns. Boy there are a few things I wouldn’t like my brothers to know that’s for sure!

  4. I doubt you’ll make it down Miss Kate, but when I get there I’ll be sure to kick that guy in the stones while he burns next to me. D-bag for sure.

  5. I understand why we have the Privacy Act for patients -but sometimes it can be a problem when the family really does need to know what is going on and can’t find out.

    I’ve been in the shoes of that brother. Although he was obvious an A-hole. He could have handled it a bit better.

  6. Oh goodie! You can sit by me…

  7. Meet me there. I’d drink if that guy was my brother too!

  8. If he could have just skipped straight to the last part, it would have saved you a lot of trouble. Egads.

  9. Some people use religon in the most stupid, self-serving and inappropriate ways. I am so sick of these self righteous idiots proclaiming to be_______ and not living what they are taught. He really may have cared about his brother’s health and just couldn’t express it properly but to give himselfthe authority to condem? what’s up with that? Being a “christian” as I am sure he proclaimed has no authority to do that…all he is upposed to do is lead by example, share warmth and love through God…he needs to get over himself.. Jerkoff. Ok off my soap box. 😉

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