The Importance of Doctor/Patient Trust

Today, I received multiple messages from my treating hospital with information I had never sought out because it was off-limits. However, they are now one of the first hospitals in the country to allow patients to view all of our medical records, respond to comments made by anyone who has treated us, and request corrections to the records themselves. This would not be a big deal, under normal circumstances. I’ve already had that level of access and would have to continually roll my eyes, be frustrated with the lies in the file, and ignore the ignorance and stupidity I was dealing with. Until today, when my psychiatric notes were revealed. I read one note from this week, scanned over it three times, and had to calm myself down because I contemplated breaking my doctor’s hands. Pissed is NOT what I felt at all. Worse, he is one of the people who knows me better than others, so I had a hard time swallowing the bullshit.

It took me leaving, and subsequently deleting, nearly ten messages before I was able to calm down enough to say, “I’m not sure if you have been made aware of the fact that I can now see your psych notes. We need to discuss this because I now feel I will have to edit 90% of what I say to you, and that is NOT how we’ve worked to establish trust as doctor and patient, not once from the first day I sat in your office. I’ve always trusted you, and you have always assured me your notes were clinical; yet THESE NOTES WERE PERSONAL. Without correction, they will follow me for the rest of my life. This needs to be addressed. You know precisely what I have been through with doctors writing their perceptions of me, as opposed to the facts I am spelling out, so we don’t need to talk about it next week, but it must be addressed at my next appointment.” I felt like I left the most honest, professional message I could, under the circumstances, and I changed my tone of voice so that he understood how this made me feel and how it would effect me moving forward.

For example, if I say, “I’m a mess.”, I don’t expect to see my doctor put that into clinical notes as the header of our discussion. Really?! Under typical conditions, I can only see we have discussed depression, trauma, PTSD, anxiety, suicidal ideation, etc. I’m using those topics as an example, not as facts. But to read my words twisted slightly to make me seem like a much different person. it retraumatized me from my previous medical trauma, and immediately made me want to say to him, “Are you OUT OF YOUR FUCKING MIND?! How stupid can you be?

Here’s what many people don’t understand about psychiatric notes; they can be subpoenaed in ANY court case. They can be used against you. One improperly written note can be twisted legally into something it isn’t. This has happened to me before; TWICE. He knows this. He knows it has deeply affected my life to terrible degrees, which is why I reacted as I did. I will, one hundred percent, be going through every damn note he writes from now on, and requesting our private discussions be removed from the medical record. They don’t belong there, especially since he processed this as “psychotherapy notes and ten minutes discussing medication”. We actually discussed medication for under five minutes total, with him saying he’d give it some thought and call me in a few days. I missed his call, and he’s damn lucky I did, because I’m not sure I’d be able to have controlled the tone of my voice or the aggression in what I was saying.

I used to wonder how he kept all of his patients lives straight, because his recollections are as precise as my own, until one day, I saw a notebook on his desk at the start of my session, and it’s one of a few he has on me. It’s a nice, leather bound notebook. The kind I’d journal in, and it is filled with his private notes on me. Lord only knows what’s in there! Yet, the actual medical record had way too much private info on me for him to claim he, “keeps it strictly clinical”. I am going to force corrections from 2017 right up until this past week. If he thinks I won’t go over it all with a fine tooth comb, then he’s forgotten the woman who first walked into his office, and declared herself, “A pretty mess.” I have been assured I looked like I was going on a date, but that nothing about what I’ve been through or said could ever be covered up with concealer and properly blended eyeshadow. At my second appointment, I tore him a new asshole for referring to my pulled together appearance as, “a mask” (after he ended the appointment by saying he was leaving in five weeks.), and he admitted I was right and he was wrong. He earned my respect by being a down-to-earth human-being who saw me as a human-being, and didn’t treat me like another annoying mental health patient who doesn’t respond well to medication. But this? This is a deal breaker. It violates everything I hold dear, and now I feel like my entire medical record needs to be turned over to me for review. If I seem like I’m calm, trust me, I’ve got fangs and I’m not afraid to claw those records apart. And I will absolutely hire a lawyer to get the personal information, which is not necessary for such records, completely omitted. He does not want to test me on this.

When my appointments were cancelled due to quarantine last March, it took me three months to get on board with Telehealth. Initially, I felt like other people needed the appointments more than I did. I had weekly appointments for months before I was forced to go down to twice a month. Before agreeing to these appointments, I kept asking myself, “Am I just a pain in the ass patient, am I a challenge for this doctor, will I ever feel better, or am I going to have to look for someone else?” I strongly considered a new psychiatrist because I was confused about how laid back and comfortable our communication is. It has always felt comfortable, human, and safe. It doesn’t feel that way now. In fact, I feel betrayed beyond words, and I wonder how much will require correction.

In this particular moment, I probably need to hear him out first, and then decide if I still want to break his hands. Of all the people I have met as psychiatrists and therapists throughout my mental health care journey, he is the first I have trusted the most. He’s also the first who isn’t completely afraid of me, but probably should be right now.

He won’t hear my message until Monday, and that’s fine. It gives me a few days to cook, read, maybe get in some yoga, do some psychic work, and remind myself that even though he’s taller than I am, I can still knock him out, and by that, I have to say that my message should be enough to make him see reason. As honest as I’ve been here, I will be ten times more honest with him because he needs to know what those notes did and can do.

Anytime there has been an issue between us, he has been good about hearing me out and fixing the problem. On that level, I should consider this before getting upset, but I couldn’t help reading through it and thinking, “Is this how you perceive me?” Because if it is, then there’s a bigger problem underneath it all and that won’t fly with me one bit.

In my message, I made it abundantly clear I might be undermining and/or underestimating my coping mechanisms going into the month of May (If you know, you know. If you don’t, you’ll see what I write next month or you can go through the previous years’ of work. It’s a rough time for me. Period.). I had said, “I don’t think I’ll make it through the month unmedicated.”, and he wants to revisit this discussion because he’s concerned about side effects, even though I suggested a medication I am extremely familiar with. I said this mostly because he will be away next month, during the worst of what I’ll be dealing with and that’s never a good feeling when I have to relive one of the worst months of my life, despite the fact that I have his permission to have him paged no matter what, and also have his personal cell phone number in case of emergencies.

The level of my trauma is a terrible loop and if I block things out, they can (and will) come up out of nowhere and throw me down a metaphorical flight of stairs. It cycles the trauma over and over again, and as he and I discussed this week, “We can’t medicate trauma.” Maybe one day, in the future, this will be possible, but for now, it isn’t. Not being about to help trauma victims and survivors is something the mental health community fails at deeply; in my personal experience.

I wanted him to know I wasn’t demanding the medication, and that I will defer to his guidance, but he also knows I agree to disagree with him a lot. And I do so respectfully. I might be upset, but that’s because this is a relationship I highly value. I’ve felt blessed that someone cared enough to have my back, and today, I felt stabbed in it by the one person who should know better because this is someone who, long before Covid, is the person I spent the most time talking to about the heaviest shit in my life. I will wait to see how this is handled on Monday, and next month when we speak at length. But I’m not going to lie; I am now contemplating dialing my appointments back to once a month and not being anywhere near as forthcoming as usual. As a direct result, I will be searching for a full-time therapist because clearly, if personal things are going to end up in the record, then he is not following proper procedure under the psychotherapy terms and conditions, where every note truly IS clinical and boring as hell.

***On the plus side, the notes state I’m ten years younger than I am, so that’s something he can keep on record. 😉 I’m maintaining the whole reverse aging thing. The fact that a specialist told me this week, “You’re young. You don’t need ANY cosmetic enhancements. There’s not a single wrinkle or mark on your face, and this has not changed since the day I met you.” These are the small things that make me smile while I am going through internal and mental HELL. Last weekend, I stopped into a liquor store to pick up wine and a few other items (I am craving Pina Coladas like nobody’s business! It’s odd. I’m not much of a drinker. I feel like quarantine turned me into a maniac I don’t always recognize.). The second I asked for two small bottles of Jack Daniels (for a recipe I love, but one that is very time consuming and doesn’t require more than a few ounces of JD. I think it calls for a few tablespoons, but I usually eyeball it.), was the moment when, not even realizing I’m behind a mask and sunglasses, the cashier asked to see identification. I could have been anyone. She couldn’t tell my height, eye color, NOTHING. Legally, they have to ask and I always offer, but it amused me. Like I said, these are the small things that make me smile.***

I hope everyone looks into their own medical records for this very reason. Don’t hesitate. Once I calm down, I’ll be tearing through mine like a starving vampire. It’s a good thing I’ve already fired most of the doctors who are in my chart, because they can’t fight me when I ask for something to be removed. It is my legal right. I’d hate to have to do the same with this doctor, so here’s hoping everything gets straightened out. I’d like to think that maybe this situation was a slip on his part, but I won’t ever make excuses for him, and he knows that.

It would be a shame for him to be on vacation with no hands. 😉 I have zero shame in being mean. After all, this involves my life. I should be fully involved in what is written about me, and so should you.

copyright © 2021 by Lisa Marino & Poison In Lethal Doses, LLC. ALL RIGHTS RESERVED.